Cardiovascular Business - October/November 2007 - (Page 15) › 690 Minute Door-to-Balloon Time steps to Betsy Bradley, phd, professor of public health at Yale university in New time and minutes really do matter when it haven, Conn., and her colleagues at the american College of Cardiology comes to getting patients to the cath lab,” d2B: an alliance for Quality, have formulated a six-step recipe for door-tosays Ting. Mayo Clinic began evaluating balloon success. “it is simple. any hospital can do this,” asserts Bradley. door-to-balloon processes at its two Roch Obtain senior management support for the initiative as well as detailed ester hospitals in 2003. At that time, the and well-defined hospital goals. median door-to-balloon time stood at 90 to 92 minutes. “Half of our patients were develop a team-based approach. door-to-balloon quality improvement above the 90 minute ceiling,” says Ting, requires change on the part of multiple internal and external staff members including emergency medical services and ed and cath lab staffs. “we were stunned.” The clinic mobilized and started a qual use a clean system to activate the entire cath team including physiity improvement process. The goal was cians, interventional staff, techs and nurses. the ed physician or other straightforward. “We wanted to consisfrontline decision-maker should be empowered to make the decision to tently and reliably achieve a door-to-balactivate the cath team. loon time of less than 90 minutes at Saint implement a simple activation method. think one call to a central page Mary’s Hospital,” states Ting. The goal operator not complex phone trees. translates into a median door-to-balloon set a standard for how quickly the cath team should be in the cath lab time of 60 to 70 minutes. ready to begin the procedure: 20 to 30 minutes is typical. The clinic turned to Lean Six Sigma tools measure performance and give feedback to the entire team including to value stream map every step that ocambulance, ed, cardiology and administrative staffs. curred after a heart attack patient arrived at the hospital, determining which processes benefit patients and which do not add value Hospital. “Each delay adds up,” notes Ting. For example, before to patient treatment. After the initial analysis, Saint Mary’s Hosthe analysis, a suspected myocardial infarction patient would repital implemented four changes. ceive an EKG in the ER. Next, the cardiac fellow was called. He → Suspected myocardial infarction patients receive an electrowalked from the floor to the ER, read the data and then called cardiogram (EKG) within five minutes of arrival in the emerthe cardiology staff to report a STEMI. This EKG acquisition regency room. The EKG does not sit outside a door waiting to view process could eat up 10 minutes or more. Next, the cardiolbe read. Instead, a nurse places it in the hands of a clinical ogist activated the cath lab with each person paged sequentially. decision-maker. “Paging could take 30 minutes,” recalls Ting. → The ED clinician activates the cath lab team with a single “Taking out the unnecessary steps reduces door-to-balloon phone call; a group page alerts the entire cath lab team. “Our time,” continues Ting. The proof is in the data at Saint Mary’s. job is to show up,” sums Ting. Over the last few years, the data consistently show a median → The hospital set a benchmark of cath lab response time of door-to-balloon time of 65 to 66 minutes with 75 to 80 percent 20 to 30 minutes. of patients under the 90 minute mark. → The entire team participates in a concurrent case review Based on the success of its local program, Mayo Clinic decided within 24 to 48 hours of each emergency cath case. To avoid to expand its D2B horizons and invited 28 regional critical acdelays, notes are sent electronically to all involved staff. cess hospitals within 150 miles of Rochester to participate in its The changes are not earth shattering, but they did produce a fast track program. Before the rural initiative, median door-tosignificant improvement in door-to-balloon time at Saint Mary’s 1 2 3 4 5 6 CardiovascularBusiness.com Cardiovascular Business 15 http://www.CardiovascularBusiness.com
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