2.50
Hdl Handle:
http://hdl.handle.net/10755/306611
Category:
Abstract
Type:
Poster
Title:
Door-to-Balloon Success 24/7
Author(s):
Tarone, Diana; Shoemaker, Melinda
Lead Author STTI Affiliation:
Non-member
Author Details:
Diana Tarone, MSN, MBA, RN, diana.tarone@sluhn.org; Melinda Shoemaker, RN
Abstract:

Evidence-based Practice Abstract

Purpose: A Door-to-Balloon (D2B) time ≤90 minutes is the goal identified by the American College of Cardiology and the American Heart Association as a measure of success. Lower comparative D2B success rates highlighted an opportunity for improvement. A multidisciplinary team of individuals crucial to initial treatment of acute STEMI was formed and D2B failures were analyzed noting the majority occurred during off hours. The goal of this project was to decrease D2B times for patients with acute STEMI and improve D2B success rates by consistently meeting the ≤90 minute goal and focusing on the off hours process.

Design: A performance improvement plan utilizing PDCA methodology was developed after completing a needs assessment and evaluating current processes.

Setting: Non-profit, tertiary care, multi-facility, regional network including a Level I trauma center and medical school.

Participants/Subjects: Patients receiving primary PCI for acute STEMI based on interpretation of the first EKG.

Methods: The baseline needs assessment revealed several barriers: lack of ECG capability in all triage rooms, varied interpretation of door time, lack of awareness of door time, documentation opportunities, and limits imposed by staff availability during off hours. The majority also had door-to-ECG times longer than the recommended 10 minutes.

Interventions were implemented. An ED technician was assigned to triage 24 hours per day. All triage rooms now have the ability to perform ECG. The door time was clearly defined and communicated. A D2B data collection sheet captured accurate times and brought awareness to all team members. A prompt for documentation of delays to PCI was added. Lastly, a process was developed to transfer off-hours acute STEMI patients to the Cath Lab more expeditiously. The patient is moved to the Cath Lab accompanied by the primary RN, ED Resident or Rapid Response Team Leader, and ED Technician prior to the arrival of the Cath Lab Team provided the patient is stable for transport. This process allows for a face-to-face handoff of care.

Results/Outcomes: Baseline data one full year prior to implementation of the off hours process exhibited an overall success rate of 89.0%. The mean and median times were 66 minutes each. The success rate for the off-hours sub-group was lower at 83.3%. The mean time was 76 minutes and the median time was 74 minutes.

The post intervention success rate improved to 98.8%. The mean time decreased to 56 minutes and the median time decreased to 57 minutes (p-value 0.002). The success rate for off-hours cases significantly improved to 97.8%. The mean time decreased to 64 minutes and the median time decreased to 62 minutes (p-value 0.001).

Implications: The data provided evidence that the new off-hours process resulted in shorter D2B times and improved success rates. Existing resources were utilized to optimize processes resulting in more efficient patient care. An important detail was the difference among hospitals based on size, available resources, and skill level of resources. With appropriate commitment from administration and the willingness of the ED and Cath Lab to work collaboratively, this performance improvement initiative is replicable at other facilities performing primary PCI regardless of size.

Keywords:
Door-to-Balloon Success
Repository Posting Date:
9-Dec-2013
Date of Publication:
9-Dec-2013
Conference Date:
2013
Conference Name:
2013 ENA Leadership Conference
Conference Host:
Emergency Nurses Association
Conference Location:
Ft. Lauderdale, Florida, USA
Description:
2013 ENA Leadership Conference Theme: Shape the Future. Held at the Greater Fort Lauderdale Broward County Convention Center
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_GB
dc.type.categoryAbstracten_GB
dc.typePosteren_GB
dc.titleDoor-to-Balloon Success 24/7en_GB
dc.contributor.authorTarone, Dianaen_GB
dc.contributor.authorShoemaker, Melindaen_GB
dc.contributor.departmentNon-memberen_GB
dc.author.detailsDiana Tarone, MSN, MBA, RN, diana.tarone@sluhn.org; Melinda Shoemaker, RNen_GB
dc.identifier.urihttp://hdl.handle.net/10755/306611-
dc.description.abstract<p>Evidence-based Practice Abstract</p><p>Purpose: A Door-to-Balloon (D2B) time ≤90 minutes is the goal identified by the American College of Cardiology and the American Heart Association as a measure of success. Lower comparative D2B success rates highlighted an opportunity for improvement. A multidisciplinary team of individuals crucial to initial treatment of acute STEMI was formed and D2B failures were analyzed noting the majority occurred during off hours. The goal of this project was to decrease D2B times for patients with acute STEMI and improve D2B success rates by consistently meeting the ≤90 minute goal and focusing on the off hours process.</p><p>Design: A performance improvement plan utilizing PDCA methodology was developed after completing a needs assessment and evaluating current processes.</p><p>Setting: Non-profit, tertiary care, multi-facility, regional network including a Level I trauma center and medical school.</p><p>Participants/Subjects: Patients receiving primary PCI for acute STEMI based on interpretation of the first EKG.</p><p>Methods: The baseline needs assessment revealed several barriers: lack of ECG capability in all triage rooms, varied interpretation of door time, lack of awareness of door time, documentation opportunities, and limits imposed by staff availability during off hours. The majority also had door-to-ECG times longer than the recommended 10 minutes.</p><p>Interventions were implemented. An ED technician was assigned to triage 24 hours per day. All triage rooms now have the ability to perform ECG. The door time was clearly defined and communicated. A D2B data collection sheet captured accurate times and brought awareness to all team members. A prompt for documentation of delays to PCI was added. Lastly, a process was developed to transfer off-hours acute STEMI patients to the Cath Lab more expeditiously. The patient is moved to the Cath Lab accompanied by the primary RN, ED Resident or Rapid Response Team Leader, and ED Technician prior to the arrival of the Cath Lab Team provided the patient is stable for transport. This process allows for a face-to-face handoff of care.</p><p>Results/Outcomes: Baseline data one full year prior to implementation of the off hours process exhibited an overall success rate of 89.0%. The mean and median times were 66 minutes each. The success rate for the off-hours sub-group was lower at 83.3%. The mean time was 76 minutes and the median time was 74 minutes.</p><p>The post intervention success rate improved to 98.8%. The mean time decreased to 56 minutes and the median time decreased to 57 minutes (p-value 0.002). The success rate for off-hours cases significantly improved to 97.8%. The mean time decreased to 64 minutes and the median time decreased to 62 minutes (p-value 0.001).</p><p>Implications: The data provided evidence that the new off-hours process resulted in shorter D2B times and improved success rates. Existing resources were utilized to optimize processes resulting in more efficient patient care. An important detail was the difference among hospitals based on size, available resources, and skill level of resources. With appropriate commitment from administration and the willingness of the ED and Cath Lab to work collaboratively, this performance improvement initiative is replicable at other facilities performing primary PCI regardless of size.</p>en_GB
dc.subjectDoor-to-Balloon Successen_GB
dc.date.available2013-12-09T17:00:43Z-
dc.date.issued2013-12-09-
dc.date.accessioned2013-12-09T17:00:43Z-
dc.conference.date2013en_GB
dc.conference.name2013 ENA Leadership Conferenceen_GB
dc.conference.hostEmergency Nurses Associationen_GB
dc.conference.locationFt. Lauderdale, Florida, USAen_GB
dc.description2013 ENA Leadership Conference Theme: Shape the Future. Held at the Greater Fort Lauderdale Broward County Convention Centeren_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission.en_GB
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