Budge Smith, MD, FACCCath Lab Medical Director, PRMCE

Western Washington Medical Group CardiologyEverett, WashingtonOctober 2009

Ongoing education effort to public and clinical staff

EMS Outreach program EKG interpretation Rapid transfer of field information to ED,

including electronic transmission Direct activation of cath lab by verbal report

from the field Potential expense with regard to false positives

Limit door to EKG time to <10 minutes If triage is full, move prioritized patient to

gurney and perform EKG in hallway Activate senior nursing staff

Designated STEMI nurse on each shift Produce and use STEMI cart Limit extraneous activities

Limit labs to I-stat labs, creatinine, hgb No CXR unless indicated

July, 2008 – June, 2009

CVL staff to ED to transport and receive report 4 staff on call Cross training is important so room set up occurs while

patient is being transported IV and groin pre done by all staff Physicians help set up, transfer, and drape patient

when applicable Do not wait on dictation Do not wait for consent

Life threatening situation Patient has received sedation Family may not be available

Dedicated information system to be able to record accurately Interface between hemodynamic and information

system Physician notes time of dilation for accuracy

and consistency Close the feedback loop with system-

generated patient report

NRMI data ACTION Data

NRMI data ACTION Data

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tco

me

(%)

* Bleeding censored at time of CABG

Risk Adjusted Mortality- Providence = 4.0%- Nation = 6.3%- Top 10% = 5.4%

NRMI data ACTION Data* Risk Models have changed over time

360 new beds Opening Fall 2011