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THE CODE STEMI PROJECT: Winning the Race CODE STEMI: The PinnacleHealth Experience Donald C. Durbeck, MD., FACC.

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Presentation on theme: "THE CODE STEMI PROJECT: Winning the Race CODE STEMI: The PinnacleHealth Experience Donald C. Durbeck, MD., FACC."— Presentation transcript:

1 THE CODE STEMI PROJECT: Winning the Race CODE STEMI: The PinnacleHealth Experience Donald C. Durbeck, MD., FACC

2 Baseline Performance

3 Evidence Based Approach Bradley EH, Curry LA, Webster TR, et al. Achieving Rapid Door-to-Balloon Times: How Top Hospitals Improve Complex Clinical Systems. Circulation 2006;113:

4 Racing Theme

5 Create a Task Force Senior Administration Support Key Stakeholders Weekly Meetings Dashboard Physician Champion Nurse Champion Quarterly Users Meeting

6 Process Map


8 Data Drives Us Initiated by ED nurse Forms kept in bin in cardiac bay Clip-on digital clocks placed on clipboard Form, clipboard, and clocks travel with patient to the cath lab Cath Lab faxes completed form Performance Improvement confirms time with scanned medical record and enters into data base


10 Immediate Feedback EARLY CASES

11 Immediate Feedback RECENT CASES

12 Immediate Feedback Be transparent, list names Bar graphs and Calendar feedback updated within one working day of case Both are ed to all members of the project Assign follow-up tasks Posted for front-line staff Ensure EMS providers also receive feedback

13 Door to EKG Pre-Hospital EKG Triage Nurse in Waiting Room 11a – 11p Triage Protocol Dedicated bay for EKG Hand Deliver EKG to ED Physician minutes

14 EKG to Lab Activation ED Physician Activates Code Stemi Activate using Pre- hospital EKG when available minutes

15 Activation to Arrival in Lab CODE STEMI Team One Call Activation using Central Page Operator Cell Phones vs. Pagers Scripted Education Prep Patient – Gown, 2 IV sites minutes

16 CODE STEMI Team Security Nursing Supervisor Performance Improvement ER and Cath Lab Personnel

17 Scripted Education PROCEDURE FOR EMERGENCY CARDIAC CATHETERIZATION Your physician believes you are having a heart attack. A heart attack occurs when an artery supplying the heart muscle becomes blocked with a blood clot. A heart attack can lead to permanent heart damage and represents a risk to your life. When treating a heart attack, time is of the essence. It is believed that if the clogged artery can be opened, the damage can be lessened and your risk of disability and death may be reduced. Your physician is proposing that you have a procedure called a cardiac catheterization. The goal of this procedure is to identify which artery of your heart is causing the attack. It is performed by a specially trained cardiologist. The procedure is done by placing a tube in an artery in your leg under local anesthesia. Dye is injected into to the arteries of your heart using x-rays. The discomfort from the procedure is generally minor. You will be given sedation as necessary. The cardiologist will attempt to identify the artery with a blood clot and re-establish blood flow by placing a small metal tube called a stent into the artery. You will receive medications to thin your blood……. INTERVENTIONALIST OBTAINS CONSENT

18 Arrival to Device Time Room ready during off hours 2 of 3 on call must be within 20 minutes All expected to be ready in 30 minutes Send patient as soon as 1 cath lab member in lab & interventionalist on site Intervene on culprit artery first minutes

19 Time to PCI

20 Analysis of Missed Opportunities Follow up missed opportunities ASAP Interview staff involved in case Follow all leads Take results of investigation to weekly task force meeting Keep running list of reason for misses Obtain necessary documentation for patient centered reason for delays

21 Patient Related Delays, excluded Required Resuscitation Patient did not give consent Needed CT Scan to rule out dissection

22 System Delays, not excluded 99 minutes (Door to EKG = 30 min) - Known COPD smoker arrived via EMS with back pain and SOB. Symptoms improved with breathing treatment in ambulance 24 minutes -3 rd STEMI in a row on a Sunday. 112 minutes (EKG to Activation = 40 min) - 1 st EKG ST wave abnormality, hesitation to activate as it may have looked like pericarditis 103 minutes (Door to EKG = 40 min) – Female c/o bilateral arm numbness, mild SOB, dizzy 95 minutes (Activation to Arrival = 50 min) – Cardiologist saw patient in ED before activating the interventionalist.

23 Data Accuracy Abstractors send list of missed opportunities at end of month to compare with our on-going list Use QNET for resolution Prior to quarterly submission to Joint Commission vendor, run final list of misses to ensure mets/not mets are coded correctly

24 Success

25 Control Chart

26 Patient Outcomes 2006

27 STEMI* In-Patient Mortality Rate * Of patients included in Primary PCI Joint Commission Measure.

28 ALL AMI In-Patient Mortality

29 Program Expansion In-Patient CODE STEMI using Rapid Response Team Transfer Patients from within the PinnacleHealth system Transfer Patients from neighboring institutions Transfer Center Helicopter services QUESTIONS?

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