CARDIAC ALERT: CARDIAC ALERT: A Change in Process. A Change in Process. Results of a STEMI Treatment Results of a STEMI Treatment Protocol Over 5 Years. Protocol Over 5 Years. Peter Kerwin, M.D., Colleen Kordish, R.N., June 10, 2008 Downers Grove Illinois ADVOCATE GOOD SAMARITAN HOSPITAL MIDWEST HEART SPECIALISTS
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CARDIAC ALERT: A Change in Process. Results of a STEMI Treatment Protocol Over 5 Years.
CARDIAC ALERT: A Change in Process. Results of a STEMI Treatment Protocol Over 5 Years. Peter Kerwin, M.D. , Colleen Kordish, R.N. , June 10, 2008 Downers Grove Illinois ADVOCATE GOOD SAMARITAN HOSPITAL MIDWEST HEART SPECIALISTS. - PowerPoint PPT Presentation
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CARDIAC ALERT:CARDIAC ALERT:A Change in Process.A Change in Process.
Results of a STEMI Treatment Results of a STEMI Treatment Protocol Over 5 Years.Protocol Over 5 Years.
Peter Kerwin, M.D.,
Colleen Kordish, R.N.,
June 10, 2008Downers Grove Illinois
ADVOCATE GOOD SAMARITAN HOSPITALMIDWEST HEART SPECIALISTS
Optimal care in the time critical Optimal care in the time critical process of treating STEMI requires a process of treating STEMI requires a coordinated protocol with EMS, ED coordinated protocol with EMS, ED and Cardiology functioning as one and Cardiology functioning as one
teamteam
Optimal care in the time critical Optimal care in the time critical process of treating STEMI requires a process of treating STEMI requires a coordinated protocol with EMS, ED coordinated protocol with EMS, ED and Cardiology functioning as one and Cardiology functioning as one
teamteam
Maintaining optimal quality over time Maintaining optimal quality over time requires continual monitoring and requires continual monitoring and evaluation of data related to the evaluation of data related to the
team’s effectiveness.team’s effectiveness.
Maintaining optimal quality over time Maintaining optimal quality over time requires continual monitoring and requires continual monitoring and evaluation of data related to the evaluation of data related to the
team’s effectiveness.team’s effectiveness.
Reasons to Improve Reasons to Improve Door to Balloon TimeDoor to Balloon TimeReasons to Improve Reasons to Improve Door to Balloon TimeDoor to Balloon Time
ACC/AHA Guidelines Mission Lifeline D2B Initiative Get With The Guidelines Core Measures Marketing
Coroner says patient's death is a Coroner says patient's death is a homicidehomicide
Woman sought care in ER for 2 Woman sought care in ER for 2 hourshours
Coroner says patient's death is a Coroner says patient's death is a homicidehomicide
Woman sought care in ER for 2 Woman sought care in ER for 2 hourshours
By Andrew L. WangTribune staff reporterPublished September 15, 2006
The death of a Waukegan woman in July after she spent nearly two hours in an emergency room waiting area was ruled a homicide Thursday during a Lake County coroner's inquest.
Door to intervention time 90 (120 min). National Average 100-110 minutes. Advocate Good Samaritan 2002: 99 min. Advocate Good Samaritan 2006: 63 min.
Decreasing D2B Time: Decreasing D2B Time: Why Should We Care?Why Should We Care?Decreasing D2B Time: Decreasing D2B Time: Why Should We Care?Why Should We Care?
400,000 STEMI per year 1/3 STEMI patients receive no reperfusion therapy Less than 40% patients receiving primary PCI have
D2B < 90 minutes Less than 10% EMS systems have 12 lead ECG
capability
• Circulation 2006;113;2152-2163
Time is Muscle!Time is Muscle! And Mortality! And Mortality!
Time is Muscle!Time is Muscle! And Mortality! And Mortality!
Each 30 minute delay in reperfusion with PCI increases 1 yr mortality 7.5%
Door to balloon <60 min, 1% 30 day mortality; Door to balloon >90 min, 6.4% mortality
“Individual commitment to a group effort- that is what makes a team work, a company work, a society work, a civilization work.”
Vince Lombardi
The Cardiac Alert TeamThe Cardiac Alert TeamThe Cardiac Alert TeamThe Cardiac Alert Team The Patient! Paramedics in the field Triage Staff ED MD’s ED RN’s Cardio diagnostics Radiology Cardiac Catheterization Lab Cardiologists Primary MD’s ICU/Floor RN’s Nurse Clinician/PA’s CV Surgery
Evidence Based Changes Evidence Based Changes Create Immediate BenefitsCreate Immediate Benefits Evidence Based Changes Evidence Based Changes Create Immediate BenefitsCreate Immediate Benefits
Cath Lab is called earlier in the process 8 minute savings
Cardiologist will accept ED MD’s initial assessment 11 minute savings
We will listen to EMS 7 minute savings
For efficiency: one call will initiate new process Hospital operator is the central communication point Cardiac Catheterization Lab is notified by this call
We will use all errors as a learning opportunity Physician Leaders role model appropriate behavior
““Outliers”Outliers”““Outliers”Outliers”
Definition specific to institution/staff Do not omit outliers Identifies the cracks in your process Analyze each case Trend outliers Example: “atypical symptoms”
Triage nurse was pre-diagnosing the patient ED physicians provided education to nursing staff “Cannot assume GI, pulmonary or musculoskeletal origin of
ED physician activates the cath lab; One call activates the cath lab; Cath lab team ready in 20-30 minutes; Prompt data feedback; Senior management commitment; Team based approach.
ConclusionsConclusionsConclusionsConclusions Effective treatment of patients with STEMI is a time
sensitive process requiring a well defined team approach.
Ongoing data collection and analysis with feedback allows for changes in process that improve care in patients with STEMI.
The role of the cardiologist in this process is not simply
that of technician. We must now be team leaders as well.
D2B of 60 minutes or less is an achievable goal likely to improve mortality in STEMI.