Cath Lab Digest - December 2007 - (Page 10) 10 STEMI INTERVENTIONS DECEMBER 2007 (and remain resolved), you enlist the help of the people that actually perform the task. This is Management 101. Empower the clinicians to find and implement solutions. We began with a few staff nurses from the cardiac cath lab and ED, and a small focus committee that quickly grew to an interdepartmental and multidisciplinary team made up of physicians, nurses, and non-medical participants. Our Health System Board recognized the importance of this issue and wanted the group to succeed. The STEMI committee, as it came to be called, soon became a stand-alone committee reporting to the hospital core measure group and the hospital CEO. Cardiologists and ED physicians were asked to join the committee and provide physician peer review and medical direction to the initiative. One of the first tasks of the team evaluating STEMI performance was to make a list of challenges to success. Communication issues were a common theme. Committee members prioritized the list and then got to work. It is important to remember that not everything is going to work the first time around. Following is a partial list of issues we compiled that impacted the delivery of efficient care for STEMI patients: 1. Many cardiac cath lab staff live greater than 30 minutes from the hospital. 2. On any given STEMI case, there are approximately 10-12 medical and non-medical staff that may be involved with direct patient care. This small handful of people are drawn from the following large group of staff at St. Luke’s. Consistency (standardization) means that all need to agree and follow protocols and processes. • 44 cardiologists on staff with interventional privileges. • 40 ED physicians • 22 cardiology fellows • 60 cardiac cath lab staff assigned to take call • 80 ED nursing staff • 17 page operators • 4 rapid response team members and nursing supervisors. 3. Less than optimal communication between cardiac cath lab staff members when responding to on-call procedures. 4. Lack of a written standard treatment protocol for STEMI patients in the ED (only acute
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