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Istat Poster Powerpoint Presentation for Emergency Nursing Association
- 1. PROBLEM: UNDER-UTILIZATION OF ISTAT TESTING IN THE EMERGENCY DEPARTMENT PLAN GOAL MULTIDISCIPLINARY TEAM MET WEEKLY TO DETERMINE WAYS TO IMPROVE UTILIZATION OF THE ISTAT PLATFORM THAT WAS PURCHASED FOR THE EMERGENCY DEPARTMENT TEAM MEMBERS NANCY GLORIUS (FACILITATOR) BONNIE SHEEDY (DIRECTOR OF ED) PAM KOTYNSKI (MANAGER LAB) SUSAN BERNARDICIUS (STAFF RN, ED) JEANNIE BURNIE (ED EDUCATOR) MARIA NEWSAD (ASST. MANAGER ED) DIANNE JENKINS (POCT COORDINATOR) Emergency Department Throughput •UTILIZE ISTAT ON 30% OF PATIENTS WHO PRESENT TO THE ED •IMPROVE PHYSICIAN ACCEPTANCE •ENHANCE RAPID RECOGNITION OF AT RISK CARDIAC PATIENTS THE TEAM MADE RECOMMENDATIONS REGARDING CHANGING THE CARTRIDGE THAT WERE AVAILABLE FOR USE: CARTRIDGES AVAILABLE AS OF 7/07 6+ - BAMP CREA – CREATININE EG7+ - BAMP + VENOUS GAS G3+ - VENOUS GAS CARTRIDGE RECOMMENDATIONS CHEM 8 TROPONIN I DO •IMPLEMENT A TRIAL WITH DEDICATED EMPLOYEE TO RUN ISTAT TESTING IN THE ED LAB FROM 11A- 11P DAILY July Aug Sept Oct Nov Dec Troponin 0 715 634 659 862 921 Chem 8 CHEST PAIN – ACUTE CORONARY SYNDROME RENAL FAILURE/ DIABETES MELLITUS CRITICAL OR UNRESPONSIVE PATIENTS REQUIRING A CAT SCAN PEDIATRIC PATIENTS TROPONIN I & CHEM 8 42 931 793 850 1037 1151 CHECK DATA WAS COLLECTED TO DETERMINE THE FOLLOWING PARAMETERS: Lab vs. POCT Turnaround Time Data Before and After Implementation CHEM 8 TROPONIN I & CHEM 8 CHEM 8 WR LOS 98 93 47 48 54 44 32 45 39 27 21 22 MD Disposition Time 2 Hrs. 10 Min. 2 Hrs. 19 Min. 2 Hrs. 57 Min. 2 Hrs. 01 Min. 1 Hr. 17 Min. 1 Hr. 11 Min. 1 Hr. 12 Min. 1 Hr. 30 Min. 1 Hr. 12 Min. 1 Hr. 05 Min. 1 Hr. 08 Min. 1 Hr. 10 Min. QUALITY/SAFETY/SERVICE: •IMPLEMENTATION OF ISTAT SPECIFIC ORDER SETS IN THE EMERGISOFT ELECTRONIC DOCUMENTATION SYSTEM THE TEAM DETERMINED THE APPROPRIATE PATIENT TYPES THAT WERE APPROPRIATE FOR ISTAT TESTING: Month (07/08) Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Lab iStat / ED •PATIENTS WITH ELEVATED TROPONINS WERE RECOGNIZED MORE QUICKLY WITH THE IMPROVED TURNAROUND TIME OF THE TROPONIN TESTING •PATIENTS FACILITATED INTO AN ED BED MORE TIMELY •PATIENTS WITH ELEVATED POTASSIUMS WERE IDENTIFIED MORE QUICKLY AND APPROPRIATE CARE WAS PROVIDED IN A MORE TIMELY MANNER ACT DUE TO THE SUCCESS OF THE PILOT THE NEW PROCESS HAS BECOME A PART OF THE ED CULTURE NEW CARTRIDES HAVE BEEN ADDED SINCE THE PILOT: BNP - TO FACILITATE CARE OF HEART FAILURE PATIENTS ABG - TO FACILITATE CARE OF PATIENTS WITH RESPIRATORY FAILURE Jan Feb Mar April May Jun Trop 1069 923 1051 955 996 1035 Chem 8 1293 1093 1219 1125 1166 1189 K+ 33 min Chem 8 10.8 min BNP 144 109 109 70 Trop 43 min Trop 18.3 min ABG 20 30 91 107