This improvement story originally appeared in IHI's 2006 Progress Report.
Time is muscle, say emergency medical professionals who treat heart attack patients. The sooner the blocked artery that causes the heart attack is reopened, the less heart muscle dies, and the faster and more complete the patient’s recovery.
At Advocate Good Samaritan Hospital outside of Chicago, Illinois, part of the Advocate Health System, the average “door-to-balloon” time — from when the patient enters the emergency department (ED) to the moment that the artery is cleared by balloon dilation in the catheterization lab — is 68 minutes, well under the recommended standard of 90 minutes.
Good Samaritan staff speed the reliable delivery of evidence-based care for acute myocardial infarction (AMI) by doing things simultaneously that they used to do sequentially. “We used to average 20 minutes to the first EKG, 25 until the ED physician saw the patient, and 45 until the cath lab was notified,” says Colleen Kordish, RN, Cardiovascular Outcomes Coordinator.
Today, when paramedics call in a possible or known AMI, the ED physician, one or two ED nurses, the EKG technician, and often a cardiologist are waiting, says Kordish. Cath lab staff members have perfected the “five minute patient prep,” quickly draping, clipping and sterilizing the cath site. “They practice on non-emergency patients who usually like it,” says Kordish. “Some even help time them.”