2.50
Hdl Handle:
http://hdl.handle.net/10755/344164
Category:
Abstract
Type:
Poster
Title:
Innovations in Heart Attack Care: Improvement Through Front-Line Engagement
Author(s):
Wilson, Jennifer; Yeager, Chad; Columbus, Barbara; Judd, Amber
Lead Author STTI Affiliation:
Non-member
Author Details:
Jennifer Wilson, BSN, RN, CEN, jenwilso@stormontvail.org; Chad Yeager, BSN, RN, CCDS; Barbara Columbus, BSN, RN, CCPC; Amber Judd, RN
Abstract:
Evidence-based Practice Abstract Purpose: CMS and American College of Cardiology/American Heart Association Guidelines for the management of patients experiencing ST-elevation myocardial infarction state that the door-to-balloon time goal for patients presenting to a facility with percutaneous coronary intervention capabilities should be 90 minutes or less. However, the 90th percentile of hospitals reporting to the ACTION database are performing procedures in this time interval around 48 minutes. Our organization set the goal to reach the benchmark of the 90th percentile by applying Lean to our door to balloon process. Design: Our institution utilized the Lean methodology and tools leveraged to identify opportunities for improvement, control and sustain our gains, and how these tools can be utilized for other process improvement initiatives. In collaboration with regional emergency medical services and front-line staff, we developed a new method for system activation and patient care delivery. Setting: A level II 586-bed trauma center located in an urban area, which also serves a large, multi-county rural population. Participants/Subjects: All ST-elevation myocardial infarction patients were included in this initiative. Methods: 8 months of baseline data was collected and analyzed for this quality improvement initiative. The aggregated D2B data (n=52) was stratified into rational subgroups and a box and whiskers plot was leveraged to graphically display cohort dispersion as well as variation, this to further inform and direct the teams improvement work. Within the philosophical improvement framework that is Lean (Value, Flow, Waste elimination), the scientific method of problem-solving (Plan/Do/Check/Act) was used to drive the effort. Multiple process-improvement tools were used at different stages in this 90 day effort including: team-based “Current-State” Process mapping, Failure Modes and Effects Analysis, and standardized work charts. Results/Outcomes: Global door-to-balloon times were reduced from a median of 62 minutes down to 45 minutes. For patients arriving via ambulance, door-to-balloon times were reduced from a median of 63 minutes down to 26 minutes. Bypassing of Emergency Department occurred 75% of the time compared to 0% pre-implementation, and field-activations by emergency medical services occurred 80% of the time compared to 15% pre-implementation. Emergency Department dwell times were reduced 66%. Implications: By engaging and empowering front-line staff, and using Lean as the process improvement method, these efforts have strengthened organizational and regional relationships, while increasing staff morale and ownership of the new processes. Furthermore, improvements to these processes have resulted in reduced total ischemic time for patients experiencing an ST-elevation myocardial infarction, which has been shown to improve patient outcomes.
Keywords:
Heart Attack Care; Innovations in Heart Attack Care
Repository Posting Date:
4-Feb-2015
Date of Publication:
4-Feb-2015
Conference Date:
2014
Conference Name:
2014 ENA Annual Conference
Conference Host:
Emergency Nurses Association
Conference Location:
Indianapolis, Indiana, U.S.A.
Description:
2014 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at the Indiana 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. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_GB
dc.type.categoryAbstracten_GB
dc.typePosteren_GB
dc.titleInnovations in Heart Attack Care: Improvement Through Front-Line Engagementen_GB
dc.contributor.authorWilson, Jenniferen_GB
dc.contributor.authorYeager, Chaden_GB
dc.contributor.authorColumbus, Barbaraen_GB
dc.contributor.authorJudd, Amberen_GB
dc.contributor.departmentNon-memberen_GB
dc.author.detailsJennifer Wilson, BSN, RN, CEN, jenwilso@stormontvail.org; Chad Yeager, BSN, RN, CCDS; Barbara Columbus, BSN, RN, CCPC; Amber Judd, RNen_GB
dc.identifier.urihttp://hdl.handle.net/10755/344164-
dc.description.abstractEvidence-based Practice Abstract Purpose: CMS and American College of Cardiology/American Heart Association Guidelines for the management of patients experiencing ST-elevation myocardial infarction state that the door-to-balloon time goal for patients presenting to a facility with percutaneous coronary intervention capabilities should be 90 minutes or less. However, the 90th percentile of hospitals reporting to the ACTION database are performing procedures in this time interval around 48 minutes. Our organization set the goal to reach the benchmark of the 90th percentile by applying Lean to our door to balloon process. Design: Our institution utilized the Lean methodology and tools leveraged to identify opportunities for improvement, control and sustain our gains, and how these tools can be utilized for other process improvement initiatives. In collaboration with regional emergency medical services and front-line staff, we developed a new method for system activation and patient care delivery. Setting: A level II 586-bed trauma center located in an urban area, which also serves a large, multi-county rural population. Participants/Subjects: All ST-elevation myocardial infarction patients were included in this initiative. Methods: 8 months of baseline data was collected and analyzed for this quality improvement initiative. The aggregated D2B data (n=52) was stratified into rational subgroups and a box and whiskers plot was leveraged to graphically display cohort dispersion as well as variation, this to further inform and direct the teams improvement work. Within the philosophical improvement framework that is Lean (Value, Flow, Waste elimination), the scientific method of problem-solving (Plan/Do/Check/Act) was used to drive the effort. Multiple process-improvement tools were used at different stages in this 90 day effort including: team-based “Current-State” Process mapping, Failure Modes and Effects Analysis, and standardized work charts. Results/Outcomes: Global door-to-balloon times were reduced from a median of 62 minutes down to 45 minutes. For patients arriving via ambulance, door-to-balloon times were reduced from a median of 63 minutes down to 26 minutes. Bypassing of Emergency Department occurred 75% of the time compared to 0% pre-implementation, and field-activations by emergency medical services occurred 80% of the time compared to 15% pre-implementation. Emergency Department dwell times were reduced 66%. Implications: By engaging and empowering front-line staff, and using Lean as the process improvement method, these efforts have strengthened organizational and regional relationships, while increasing staff morale and ownership of the new processes. Furthermore, improvements to these processes have resulted in reduced total ischemic time for patients experiencing an ST-elevation myocardial infarction, which has been shown to improve patient outcomes.en_GB
dc.subjectHeart Attack Careen_GB
dc.subjectInnovations in Heart Attack Careen_GB
dc.date.available2015-02-04T11:27:38Z-
dc.date.issued2015-02-04-
dc.date.accessioned2015-02-04T11:27:38Z-
dc.conference.date2014en_GB
dc.conference.name2014 ENA Annual Conferenceen_GB
dc.conference.hostEmergency Nurses Associationen_GB
dc.conference.locationIndianapolis, Indiana, U.S.A.en_GB
dc.description2014 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at the Indiana 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. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.en_GB
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