This story originally appeared in IHI's 2007 Annual Progress Report.
The culture at Immanuel St. Joseph Hospital in Mankato, Minnesota, supports continuous improvement and promotes the use of evidence-based practice. “It begins with leadership,” says Patricia Bielke, RN, MA, CPHQ, Quality Improvement Coordinator. “If the leaders don’t articulate continuous improvement as their primary expectation, then the rest of the organization can’t do it.”
This culture is the foundation supporting improvement in AMI care
, and it’s not focused only on reducing the time it takes for emergency patients to get from the ED to the cath lab. “Some of our focus is on making sure we recognize the patients whose symptoms are atypical, who might already be hospitalized for some other reason,” says Bielke.
Bielke says two nurses from cardiac rehab and the cath lab receive and review daily lab reports listing any of the hospital’s 140 to 150 patients who have elevated troponins or heart muscle proteins, an indication of a possible AMI. “Then they can prompt appropriate care for those patients. This is a piece that didn’t used to happen. A basic principle of high reliability is focusing on your defects, and this is one we have fixed. What we pay attention to, we can do well. What we don’t pay attention to, we can’t. So we try to pay attention to everything.”