Cath Lab Digest - May 2008 - (Page 14)

14 STEMI INTERVENTIONS MAY 2008 was 69 minutes, with 84% treatment within 90 minutes. As our efficiency continues to improve, we have identified a few important barriers. Barriers One barrier that has been identified has been lack of physician compliance with provision of an accurate interventionalist call schedule to the ED. This problem has been resolved by daily verification and confirmation of the interventionalist call schedule for the following day by our cath lab manager and scheduler. This information is communicated to the ED daily. For assigned patients (patients with an established cardiologist), our policy is to call the assigned cardiologist and allow ten minutes for response prior to resorting to the interventionalist on call for ED STEMI patients. Additionally, on-site call rooms has resulted in less compliance with the cath lab team 30-minute arrival rule. This reduced compliance is primarily due to staff dissatisfaction with these rooms compared with hotel rooms, which allow them to be with their families while on call. Negotiations are currently underway to try to solve these accommodation issues. Conclusion Performance improvement strategies to improve door-to-PCI times for ED STEMI patients involve interdisciplinary teamwork along with careful examination of care processes, comprehensive data collection and meticulous data analysis. Administrative, physician and staff support are vital. ■ The authors can be contacted at dyarde@sjha.org Figure 1. Results References Figure 2. 1. Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction — executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction). Circulation 2004 Aug 3;110(5):588-636. 2. Cardiovascular Watch. Case Study: Baptist Hospital East (Ky.) reduces door-to-balloon time through care process improvements. 12/17/2004. Available at: www.advisory. com (membership required). STEMI INTERVENTIONS: Commentary Sameer Mehta, MD, FACC, MBA is studying ST-elevation myocardial infarction interventions in his work with short door-to-balloon time primary PCI and the Single INdividual Community Experience REgistry for Primary PCI (SINCERE) database at 5 community hospitals in Miami, Florida, now over 311 patients. A past chief of interventional cardiology and director of the cardiovascular laboratory at Cedars Medical Center in Miami, as well as former President of the American Heart Association (Miami Dade Division), Dr. Mehta is a Voluntary Associate Clinical Professor of Medicine at the University of Miami-School of Medicine. Dr. Mehta is also president of the Indo-American Society of Interventional Cardiologists (ISIC) and a course director for the Lumen-Vascular Interventions Symposium. He has recently published the Textbook of STEMI Interventions (available through HMP Communications, at http:// www.stemiinterventions.com). Dr. Mehta will be commenting on the important work going on around the world as societies and their hospitals struggle to educate patients about the importance of timely intervention in ST-elevation myocardial infarction, and work collaboratively to decrease the time from patient arrival to intervention. The present issue of the Cath Lab Digest features another wonderful success-story in achieving door-to-balloon (D2B) time success at a famed institution in Atlanta! Sara Moseley, Deryck Yarde, Haleh Eskandari and Dr. Jack Chen deserve felicitations for orchestrating prudent process changes at Saint Joseph’s signs it. After examining the patient, if a STEMI diagnosis is made, the ED physician immediately initiates a one-call page to notify the STEMI team. The cardiologist is notified simultaneously. The first two cath lab team members are expected on site within 30 minutes. Although oncall cath lab team members who cannot meet this requirement were initially provided lodging in a nearby hotel, we now have an on-site call room. Pastoral care, radiology and security personnel report to the ED immediately to assist as needed. Accurate time-keeping is assured because cath lab and ED computer clocks have been synchronized with U.S. Naval Observatory time. The purchase of radio-signal clocks is being considered as a means to further ensure accuracy of timing. Evaluation Data gathered for the first half of 2005 showed improvement beginning in March. Our average door-to-PCI time for a total of eight cases in March was 98.6 minutes. The percent of STEMI cases having an open artery within 90 minutes was 38%. Throughout the remainder of 2005, performance continued to improve. Our mean door-to-PCI time for the year 2005 had decreased to 96 minutes for 68 cases, with 48% in <90 minutes. For 2006, our average doorto-PCI time, representing 80 patients, was 76 minutes, with 75% of first inflations within 90 minutes. (It should be noted that in 2006, the Atlanta Time Program was implemented. This consortium of five area hospitals ensured that patients requiring primary PCI would be transported to the nearest treatment facility by participating EMS providers. Pre-hospital EKGs were reported or transmitted by the EMS.) For 2007, with 81 cases, our average door-to-PCI time http://www.stemiinterventions.com

Table of Contents Feed for the Digital Edition of Cath Lab Digest - May 2008

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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