Ek Gdoor2doctimes
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QI project to decrease EKG door-to-doctor times in busy ER as part of Chest Pain Center .
![Raising the Bar for Health Care Performance Beverly J. Miller, RN, MSN, CNS, NP Clinical Educator/Supervisor RN WakeMed North Healthplex Emergency Services [email_address] 2009.07.25 Strategy to Pursue Perfection: “ EKG Door-to-Doc < 10 min”](https://image.slidesharecdn.com/ekgdoor2doctimes-12508380788516-phpapp03/85/Ek-Gdoor2doctimes-1-320.jpg)
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Ek Gdoor2doctimes
- 1. Raising the Bar for Health Care Performance Beverly J. Miller, RN, MSN, CNS, NP Clinical Educator/Supervisor RN WakeMed North Healthplex Emergency Services [email_address] 2009.07.25 Strategy to Pursue Perfection: “ EKG Door-to-Doc < 10 min”
- 14. 2009.06.25 BJM Designated EKG tech each shift
- 16. First Month Failures in EKG DOOR-TO-DOC Times Date EKG Time Reason for Delay 6/25/2009 28 report of "burning sensation in chest" (old paradigm) 6/25/2009 11 attempted to do more complete registration 6/27/2009 12 PAR used pager instead of Nextel direct connect radio 6/28/2009 11 delay in order entry 7/17/2009 11 delay in order entry Data Analysis
- 17. The EKG IS the screen
Editor's Notes
- At WakeMed North Healthplex Emergency Department, we set the bar high for health care performance. We strive for perfection in all that we do. This presentation will review a recent QI project undertaken in the pursuit of service excellence and process perfection.
- Because WakeMed is a recognized chest pain center, all Emergency Departments are expected to achieve rapid EKG times for all adult patients (aged 18 and over) who present with a complaint. This is a blanket expectation without exception…and irrespective of the RNs clinical evaluation of what the underlying problem might be…even irrespective of the possibility of an individual using a complaint of “chest Pain” in the hopes of being seen sooner.
- The department was experiencing a bit of a conundrum. Because WakeMed North Emergency Department is blessed with many exceptional and highly experienced RNs, one would expect EKG times to be rapid. In reality, the opposite was true. The RNs were ‘pre-screening’ patients into presumed diagnostic categories (i.e., asthma, bronchitis, sinusitis with cough, referred gallbladder pain, or atypical chest wall pain). This resulted in EKG times being delayed.
- Who needs to meet? (everyone involved) What do we need to discuss? (What happens and how we can create a good process.) When can we meet? (what time today) Where do we meet (and where do we start)? Why do we have to worry about this? (because it impacts patient safety AND satisfaction) How do we change the process? (where can we fix things)
- The clock starts as soon as the adult patient presents to the Emergency Department registration desk and the Patient Account Reps (PARs).
- Audits of charts for the month prior to the QI project were a real surprise (and quite lower than before). We are doing more EKGs with the new policy and the time spans had drifted somewhat dramatically.
- How did the current (old) process work… how were people working independently in this process and how could we work together better ?)
- There was a lot of discussion about patients’ use of the term “chest pain” and how staff ultimately respond. It quickly became apparent that we must develop a paradigm that is consistent with best practices, service excellence and the ultimate in patient safety! We needed a new paradigm to replace the mind-chatter RNs were experiencing.
- The nurses needed to understand that they can actually provide better patient care and actually get off the hook faster with those patients who have other issues in play by facilitating a rapid EKG to the doctor upon the patient’s arrival.
- Differences between old process and new process.
- Slide 11 of 17: PAR responsibilities
- Slide 12 of 17: Triage #2 set up with a second EKG machine and designated our chest pain / ekg room. Task assignments for team members
- Slide 13 of 17: education to department regarding changes to procedure and expectations
- Slide 14 of 17: The chest Pain Process: EKG Door to Doc <10 min flowchart. The main copy of this was laminated, placed a t the physicians’ desk, the clinician’s desk, each nursing station, Minor Emergent Care, Registration desk and in all triage rooms. Additionally, a copy of the process and an educational powerpointpresentation were sent.
- Slide 15: overview of reaction and adaptation to changes. Plan for monitoring
- Slide 16: data analysis of first ont post procedural change
- Slide 17 of 17: the new paradigm