Processes to Decrease

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Processes to Decrease

  1. 1. 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
  2. 2. Background <ul><li>Pre-hospital (EMS), Emergency Department (ED), and Cardiology/Cath Lab processes play key roles in reducing Door-to-Balloon (D2B) times </li></ul><ul><li>Our non-profit, community hospital has utilized the ACC/AHA STEMI guidelines of care since 2001 to triage and manage STEMI patients </li></ul>
  3. 3. Methods <ul><li>A multidisciplinary team divided D2B time into three primary intervals with specific targets </li></ul><ul><ul><li>ED Door to 1st ECG time (5 minutes) </li></ul></ul><ul><ul><li>ED Door to Cath Lab Door time (60 minutes) </li></ul></ul><ul><ul><li>Cath Lab Door to Balloon Deployment time (20 minutes) </li></ul></ul>
  4. 4. ED Door to1st ECG time <ul><li>Implementation of remote EMS 12-lead ECG transmission </li></ul><ul><li>Placement of a dedicated bed in ED Triage for stat ECGs </li></ul><ul><li>Trained ED staff to perform 12-lead ECGs </li></ul>
  5. 5. ED Door to Cath Lab Door Time <ul><li>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 </li></ul><ul><li>Activation of the cath lab team which prepares the cath lab and then goes immediately to the ED to expedite transporting the patient </li></ul>
  6. 6. Cath Lab Door to Balloon Deployment Time <ul><li>Utilizing high volume operators </li></ul><ul><li>Developing standardized protocols for angiography </li></ul>
  7. 7. Additional General Methods <ul><li>Ongoing data monitoring and immediate information feedback was a critical factor in reducing D2B time </li></ul>
  8. 8. Results 276 Patients Evaluated
  9. 13. Conclusion <ul><li>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 </li></ul>

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