Processes to Decrease
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Processes to Decrease Door-to-Balloon Times for STEMI Patients in a Community Hospital Sam Ward MD FACC, Pamela Goepfarth MBA RN-C, Mark Izzo MD FACC, William Mecca MD FACC, Wayne Jones DO, Joseph Cacchione MD FACC Saint Vincent Health Center Erie, Pennsylvania
Transcript of Processes to Decrease
Processes to Decrease Door-to-Balloon Times for STEMI Patients
in a Community Hospital
Sam Ward MD FACC, Pamela Goepfarth MBA RN-C,Mark Izzo MD FACC, William Mecca MD FACC,Wayne Jones DO, Joseph Cacchione MD FACC
Saint Vincent Health CenterErie, Pennsylvania
Background• Pre-hospital (EMS), Emergency
Department (ED), and Cardiology/Cath Lab processes play key roles in reducing Door-to-Balloon (D2B) times
• Our non-profit, community hospital has utilized the ACC/AHA STEMI guidelines of care since 2001 to triage and manage STEMI patients
Methods
• A multidisciplinary team divided D2B time into three primary intervals with specific targets – ED Door to 1st ECG time (5 minutes) – ED Door to Cath Lab Door time (60 minutes)– Cath Lab Door to Balloon Deployment time
(20 minutes)
ED Door to1st ECG time
• Implementation of remote EMS 12-lead ECG transmission
• Placement of a dedicated bed in ED Triage for stat ECGs
• Trained ED staff to perform 12-lead ECGs
ED Door to Cath Lab Door Time
• Utilization of 24/7 in-hospital cardiology coverage resulting in 5-minute Cardiology response time when a STEMI alert (Code Heart Stat) is called by the ED
• Activation of the cath lab team which prepares the cath lab and then goes immediately to the ED to expedite transporting the patient
Cath Lab Door to Balloon Deployment Time
• Utilizing high volume operators • Developing standardized protocols for
angiography
Additional General Methods
• Ongoing data monitoring and immediate information feedback was a critical factor in reducing D2B time
Results
276 Patients Evaluated
% ECG ≤5 minutes
10%
20%
33%
49% 48%
35%
0%Baseline 2001 2002 (n=52) 2003 (n=50) 2004 (n=49) 2005 (n=45) 2006 (n=57) 2007 (to June
n=23)
%ECG≤5m Linear (%ECG≤5m)
Median D2B Minutes
8370
60 61 54 5142
25
25
25 2219 21
28
90
56610121215
Baseline 2001 2002 (n=52) 2003 (n=50) 2004 (n=49) 2005 (n=45) 2006 (n=57) 2007 (to Junen=23)
ED Door2 CathLab CathLab2 Balloon ED Door2 1st ECG Internal Target
D2B Median Times
90
108
85 83
73 72 70
95
Baseline 2001 2002 (n=52) 2003 (n=50) 2004 (n=49) 2005 (n=45) 2006 (n=57) 2007 (to Junen=23)
Internal Target D2B
%D2B ≤ 90 minutes
25%
61%65%
70%
87% 86%93%
Baseline 2001 2002 (n=52) 2003 (n=50) 2004 (n=49) 2005 (n=45) 2006 (n=57) 2007 (to Junen=23)
Conclusion
• A systematic approach enhanced and made more stable by in-house cardiology along with real-time information feedback has helped reduce and maintain D2B time at 90 minutes
