Cath Lab Digest - May 2008 - (Page 12)

12 STEMI INTERVENTIONS MAY 2008 Continued from page 1 • Delayed times from 12 noon to 4 pm. Performance Improvement Strategies Speed Up Treatment Times in the Management of ST-Elevation Myocardial Infarction (STEMI) Patients Caring for Atlanta for more than 125 years, Saint Joseph’s Hospital is the city’s oldest hospital and one of the leading acute-care referral centers in the Southeast. Saint Joseph’s was the first hospital in the region to develop a comprehensive cardiac catheterization laboratory (cath lab) and the first hospital in the Southeast to offer angioplasty as an alternative to bypass surgery. Saint Joseph’s is one of three hospitals in the United States, and the only one in Atlanta, to receive Magnet Recognition for Nursing Excellence three consecutive times. In 2007, we served 1,298 MI patients, with over 80% transferred from other facilities. Eighty-one STEMI patients were admitted through our emergency department (ED). In 2007, our volumes for diagnostic and interventional cardiac catheterization procedures were 5,170 and 1,830, respectively. Saint Joseph’s has seven catheterization, two electrophysiology, and one shared catheterization/electrophysiology laboratory. In total, we are staffed by 13 cardiology groups and 61 cardiologists, with 23 board-certified interventional cardiologists. Performance Improvement Steps A multi-disciplinary ED to PCI Performance Improvement Team was formed to evaluate our current practice and to optimize strategies for managing STEMI patients who arrive directly to our ED. The team began regular monthly meetings in August 2004. Team members included cardiologists, ED physicians, hospital executives, directors and managers of the ED, cath lab, nursing, information technology and patient safety and quality. A core measures performance improvement coordinator provided data and case studies to identify priority areas for improvement and factors contributing to success. The team proposed the following steps to accelerate diagnosis and treatment times for STEMI patients: • Establish written STEMI time target goals for each step of the process, from arrival to PCI. • Dedicate a private, specific area in the ED for performing 12lead EKGs on all patients with suspected AMI to assess for ST elevation within 10 minutes of arrival. These are performed by ED personnel on machines stationed in the ED. • Ensure that the EKG is then immediately carried to the ED • Data Collection and Problem Identification In 2004, data gathered on 100% of MI patients identified 13-20 primary PCIs for STEMI per quarter. Only 16% of STEMI patients had an open artery within 90 minutes. Delays at that time were identified as: • Delayed identification of STEMI, due to delays in either performance of, or physician interpretation of, the electrocardiogram (EKG) • Delayed response from the nursing supervisor to notify the cath lab team • Excessive number of telephone calls required to reach all team members • Delayed response from security service when called by the ED to secure the patient’s valuables • Delayed cath lab team arrival • • • • Table 1. STEMI Time Target Goals Goal (maximum time in minutes) 0 5 10 12 15 15 Action Person Responsible • Patient arrival in ED Triage, monitor, O2, IV, labs 12-Lead EKG ED MD Exam/EKG interpretation Group page activated for STEMI Emergency Response Team* Cardiologist and interventional cardiologist called STAT, giving information that this is a “STEMI PATIENT” Chest x-ray Consider thrombolytic therapy Administer thrombolytic if PCI delayed and no contraindications Cath lab team starts set up ED patient ready for cath lab Patient is transported to the cath lab Cath table is ready Patient arrives in cath lab First balloon inflation/intervention to open artery Triage or Charge Nurse Triage or Charge Nurse or designee ED MD ED MD or ED MD’s designee ED MD or ED MD’s designee Radiology technician • physician, who examines it for ST elevation and initials it. If ST elevation is present, the ED physician immediately examines the patient and alerts the cath lab team and the interventionalist. Establish a written protocol for notification of all members of the STEMI team, including the nursing supervisor, cath lab team, EKG tech, pastoral care, radiology and security with a single telephone call. This onecall paging system is in place 24 hours a day, 7 days a week. Adjust cath lab staffing to improve efficiency from 12 noon to 4 pm. Celebrate success by recognizing STEMI team members who have participated in STEMI cases treated within 90 minutes. Recognitions are made with “Caught by an Angel” cards, which are part of a preexisting hospital award system. Also, all participants in the case, from technologists to physicians are recognized on a “Celebrating Success” photo display posted in the ED and in the cath lab. This photo display is updated weekly. Collect data on cath lab team arrival times. During weekends and after normal hours of cath lab operation, provide a place for oncall cath lab team members to stay overnight if they are unable to reach the hospital within 30 minutes. Assure accurate time-keeping by synchronizing the ED computer clocks with the cath lab clocks. Utilize pre-hospital EKGs whenever available. The cath team and the interventionalist are notified prior to the patient’s arrival. 15 20 30 35 40 40 45 45 90 Implementation ED MD/Cardiologist ED RN Cath team ED RN Cath lab team member Cath team Cath lab team member Interventional cardiologist Written STEMI time target goals were established and approved by the cardiology and ED section chiefs, and all team members. Construction of a private area in the ED for rapid 12-lead EKG performance was completed, and patients with suspected AMI undergo 12-lead EKG testing by an ED technician within 10 minutes of arrival. The EKG is given immediately to the ED physician who writes the date and time on the tracing and *The STEMI Emergency Response Team includes cath lab team, nursing supervisor, EKG, pastoral care, radiology and security.

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Cath Lab Digest - May 2008 The King Faisal Specialist Hospital and Research Centre Cell Therapy in the Cath Lab for Heart Failure: A Look at MyoCell® Therapy and the SEISMIC Trial Performance Improvement Strategies Speed Up Treatment Times in the Management of ST-Elevation Myocardial Infarction (STEMI) Patients Contents Clinical Editor’s Corner Commentary: Performance Improvement Strategies Speed Up Treatment Times in the Management of ST-Elevation Myocardial Infarction (STEMI) Patients Ask the STEMI Expert Comparing Drug-Eluting Stents and Bare-Metal Stents SICP: The Ten-Minute Interview with… Christopher Kambak, RT(R) Cardiac Cath Lab Economics in a Public Hospital of a Developing Country Keeping Your Heart & Vascular Employees: Proven Ideas for an Effective Retention Plan Unspoken Words Ask the Clinical Instructor Society of Invasive Cardiovascular Professionals Meetings Calendar Education Center What Do You Think? Clinical & Industry News Classifieds Advertisers Index

Cath Lab Digest - May 2008

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