1. INTERDISCIPLINARY COLLABORATION TO REDUCE D2B TIME Andrew Ball, MD Abington Memorial Hospital

2. Suburban Philadelphia Community teaching hospital Beds: 560 Yearly emergency visits: 86,386 PCI for STEMI at Abington 24/7/365 since 1997

3. Where to Start Assemble the D2B team Review the literature Get input from front line personnel Identify barriers Perform in-depth data analysis

4. Abingtons D2B Team Not just multi-discipline but the right leaders from each stakeholder Chief of Staff Internal Medicine Cardiology Emergency Medicine Nursing Cardiac Catheterization Laboratory (CCL) Clinical Information Services Patient Safety & Healthcare Quality

5. Identifying Barriers Multiple EMS organizations with limited transmission capability Two private cardiology groups with interventionalists No cardiology fellows CCL staff take call from home with 45 minute radius allowed

6. Data Analysis Core Measure data limitations Internal data analysis Every case Breakdown into key intervals Information spread

7. Abingtons Baseline Results - 2005 IntervalTime (min) Arrival to ECG done14 ECG done to EP4 EP to Interventionalist call5 Interventionalist to CCL arrival49 CCL arrival to anesthetic15 Anesthetic to Balloon22 Door to Balloon109 Patients with D2B < 90 min35% Patients with D2B < 60 min2%

8. Multidisciplinary Solutions Multiple leaders Define roles and responsibilities Targeted solutions based on real problems Pre-hospital ECG Walk-in to ECG performance CCL mobilization by emergency physician Single interventionalist on call Rapid communication to critical staff CCU nursing support in the ED CCL equipment preparation by inpatient nursing Timing of patient transfer Real time feedback

9. PCI ALERT Incorporated multiple improvement suggestions Explicitly defined roles and responsibilities Streamlined communication Identified the care as a team event Patient centered

10. Results after PCI Alert Go-live 2/07 Interval Time (min)Change (min) Arrival to ECG done8 6 ECG done to EP2 2 EP to Interventionalist call3 2 Interventionalist to CCL arrival33 16 CCL arrival to anesthetic13 2 Anesthetic to Balloon18 4 Door to Balloon77 31 Patients with D2B < 90 min75% 40 % Patients with D2B < 60 min31% 29 %