Cardiovascular Business - October/November 2007 - (Page 16) strategies tO trim dOOr-tO-BallOON time › sentara health, a seven-hospital system based in Norfolk, va., used the aCC door-toballoon initiative as a springboard for quality improvement across the system. “the aCC sentara norfolk General Hospital has initiative has created beat the clock—achieving less than focus and support. se90-minute door-to-balloon times thanks to better staff paging protonior management is cols and frequent reviews of the plan. committed, which is very important,” says john Brush, md, chair of the acute myocardial infarction committee at sentara health southside and a cardiologist in private practice. the six strategies provide a good starting point and specific directions for hospitals, so they need not re-invent the wheel, Brush says. sentara health has embraced and tweaked the strategies to fit its needs. One of the key, early changes is the er activation of the cath lab and a single page of essential staff. “it eliminates the all-too-common phone tag that eats up time. and there’s no cost involved; it’s an attainable quality improvement that doesn’t require spending money on equipment or personnel,” explains Brush. each five minutes trimmed from the process adds up, he says. One sentara site implemented an overhead stemi (st elevation myocardial infarction) alert page that can be heard hospital-wide five minutes before a page hits a physician’s beeper. the health system also relies on enhanced data feedback. since its involvement with the aCC d2B alliance sentara health has developed a real-time data feedback system that consists of an email within 24 hours of each stemi; all involved personnel receive data detailing various times such as door to eKg, er call to cardiologist and patient transfer from ed to cath lab. in addition, every month the team reviews aggregate data to determine potential improvements. the health system also shares ideas across facilities. Consequently, multiple sentara hospitals use the same checklist and engage in regular mock cases to practice skills. the effort is paying off. sentara leigh hospital, for example, consistently turns around most patients in less than 90 minutes. 6 steps in Practice balloon time in the 28-hospital group stood at three hours. But after implementing changes based on the initial success at Saint Mary’s Hospital, the group slashed its door-to-balloon time to 112 minutes, with about half of the time spent in helicopter transport from the home hospital to the cath lab site. Mayo Clinic initiated a similar quality improvement process at the critical access hospitals, beginning with value stream maps. Some newly standardized procedures mirror those at Saint Mary’s. For example, ED physicians now activate offsite cath labs with a single phone call. Protocols are standardized across all sites, so that all STEMI patients receive the same drugs and preparations. The new and improved process, however, involves a conference call between Mayo Clinic and an ER nurse that provides access to Mayo Clinic’s three helicopters and all emergency helicopters in Minnesota. Ting insists, “Our intent with the fast track initiative was not to grow our market share, but to improve the quality of care across the region.” In fact, Mayo Clinic actually refers some hospitals to a more accessible cath lab depending on their location. Wedding high-tech and high touch Carolinas Medical Center-NorthEast is a suburban hospital that has successfully combined patient education and state-of-theart technology to bring its median door-to-balloon time to 60 to 65 minutes. “There are several obstacles to meeting the new ACC guidelines,” admits Paul Campbell, MD, cardiologist with Heart Group of the Carolinas. For starters, physicians can’t treat patients who ignore heart attack symptoms and delay seeking treatment. The medical center addressed the challenge with a major educational campaign in both English and Spanish, educating local residents about the signs and symptoms of a heart attack and encouraging them to dial 911 if a heart attack is suspected. The other essential components of success are coordination among the various disciplines involved in triaging, transporting and treating myocardial infarction. Several years ago, Carolinas Medical Center-NorthEast and the local ambulance service teamed up to equip ambulances with a 12-lead EKG that could be wirelessly transmitted to the ER. Cardiologists review the data on handheld computers, and 16 Cardiovascular Business October/November 2007
For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.