Cardiovascular Business - October/November 2007 - (Page 17) bergan Mercy Medical Center, part of alegent Health of omaha, neb., consistently operates with door-to-balloon time in the range of one hour—some 30 minutes faster than the quality standard recommends. in some cases, patients are able to bypass the ER for a lightening fast angioplasty. Since beginning its effort, Carolinas Medical Center has seen the percent of myocardial infarction patients using ambulance services increase from under 40 percent to 50 percent. But hospitals still need a smooth transmission for patients arriving by private car. Carolinas Medical Center relies on a team approach, soliciting suggestions from all stakeholders in the process. Cardiology and ED worked together to determine gaps and needs. Cardiologists trained ER staff to better recognize and triage heart attack patients, particularly atypical cases like patients with abdominal or back pain. The next step entailed creating a streamlined order sheet with clear responsibilities for each party. The ER is responsible for a heparin bolus and aspirin and Plavix administration. Cath lab staff mix the IV drip and shave the patient’s groin area. It’s inefficient for an ER nurse who only shaves one groin a day to complete this task when our staff shaves 10 a day, says Campbell. Other efficiency boosters include acute coronary care unit (ACCU) secretaries, who proactively obtain patient names and demographics to enter into the computer before patients arrive in the cath lab. Consequently, interventional cardiologists don’t have to input this data into the computer before beginning the procedure. In addition, several clinical staff members are crosstrained in the cath lab and ACCU, so the team is not delayed if someone is stuck in traffic. Thaddeus Woods, MD, director of the emergency department at Bergan Mercy. About 80 percent of the center’s chest pain patients present in a private car. The key, says Woods, is obtaining the EKG in a timely fashion, so ED staff are trained to move chest pain patients to the front of the line. The EKG is handed to a physician who can call and activate the cath lab if necessary. “Everything is hardwired,” reports Woods. Like other D2B stars, Bergan Mercy Medical Center uses a standard acute MI order set in the ER. The ER staff obtains patient consent, weighs, shaves, medicates and transports the patient, enabling the cath lab to focus on its task. Woods stresses the importance of other key components—bimonthly meetings to review data and discuss quality and public awareness. During the regular meetings, the entire team reviews chest pain data. “When we look at the data and plot it out, we can see where there is room for improvement,” notes Vice President of Cardiology John May. Woods says facilities can garner improvement by honing in on the longest delays and working from that point. Making the 90 minute mark The team approach Alegent Health, a nine-hospital healthcare system based in Nebraska and Iowa, boasts sub-90 minute door-to-balloon times in five of its nine metropolitan hospitals. In fact, Bergan Mercy Medical Center in Omaha, Neb., averages a 60-minute turnaround. “We attribute our success to a team approach,” says The ACC has brought national attention to the door-to-balloon quality indicator. Hundreds of hospitals across the country have joined the D2B Alliance in an attempt to improve their response time and better patient care. It’s a valuable initiative as door-to-balloon time correlates with patient survival and better outcomes, and sites can trim their time without a tremendous financial outlay. The tickets to success include: rapid EKG studies, prompt and efficient communication between the ED and cath lab, single call activation of the cath lab, rapid response on the part of the cath team and ongoing assessment and refinement of efforts. CardiovascularBusiness.com Cardiovascular Business 17 http://www.CardiovascularBusiness.com
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.