Mayo Clinic RochesterRochester
, USATeamLuis Haro, MD Quality Chair Dept of EM, Mayo Clinic Rochester
Patty Geerdes, RN, Quality Office, Mayo Clinic Rochester
Charanjit Rihal, MD, Cath Lab Director Consultant Cardiology, Mayo Clinic Rochester
Malcolm Bell, MD, CCU Director Consultant Cardiology, Mayo Clinic Rochester
Choon-Chern Lim, Health Care Policy & Research, Mayo Clinic Rochester
Eric Boie, MD, Practice Chair Dept of EM, Mayo Clinic Rochester
Wyatt Decker, MD, Chair Dept of EM, Mayo Clinic Rochester
Dennis Weivoda, RN, CI Coordinator Dept of ED, Mayo Clinic Rochester
Janet Finley, RN, Clinic Nurse Specialist ED, Mayo Clinic Rochester
Paul Travis, RN, Cath Lab Nurse Supervisor, Mayo Clinic Rochester
Loretta Mueller, Operations ED, Mayo Clinic Rochester
Selina Johnson, Operations ED, Mayo Clinic Rochester
Jeff Tri, Communications Engineer, Mayo Clinic Rochester
Terre McJoynt, Emergency Communications, Mayo Clinic RochesterAimTo decrease the door-to-balloon time for patients with ST segment elevation myocardial infarction (STEMI) who come through the emergency department (ED), to meet the standard of less than 90 minutes.Measures
Door-to-initial ECG – (Goal: 5 minutes)
Door-to-Cath team notified – (Goal: 15 minutes)
Door-to-Departed-to-Cath Lab – (Goal: 45 minutes)
Door-to-Percutaneous Intervention (PCI) – (Goal: 90 minutes)
In an effort to decrease the time to less than 90 minutes, a multidisciplinary team was formed. Changes in flow of care, communications, cardiac catheterization team activation and data collection were made. Changes in practice implemented at Mayo Clinic Rochester (MCR) were based on prior published suggestions on how to decrease door-to-needle time in the era of thrombolysis. Other changes were made based on the PDSA cycle performed through this project.
The most significant changes associated with decreased door-to-balloon time were:
- Emergency physician activation of cardiac catheterization team by a group page activation
- Predetermined time-based goals for each step of the patient care process (i.e., door-to-ECD of less than 5 minutes, door-to-team activation of less than 15 minutes, door-to-ED departure of less than 45 minutes, and finally door-to-balloon time of less than 90 minutes)
- Stong interdepartmental communication between Cardiology, Emergency Medicine, Communications, Quality and Nursing
- Prompt feedback of time-based results to staff involved in the care of the STEMI patients
Summary of Results / Lessons Learned / Next Steps
On May 17, 2004 the practice changes were implemented. Data was collected at the bedside in a web based format, created strictly for this population. It was then evaluated by the multidisciplinary team leadership on a bi-weekly basis for accuracy and quality control. Physician support has been instrumental in making these changes happen. Improvement processes and results have been readily shared with the team involved with the STEMI patients.
Our results showed a dramatic decrease in door-to-balloon time. We had a total of 32 consecutive patients for the timeframe of May 17, 2004 to August 31, 2004. The mean door-to-balloon time was 70 minutes. Important concepts that assisted in this success were:
Get the right people involved. A multidisciplinary team assists in identifying problems/issues, and helps to make changes easier.
Communication to all areas of this project is a necessity.
Use of the PDSA cycle assisted us in getting rapid changes completed.
Make the process as simple as possible.
Sharing the data at real time, via graphs, charts, etc, assists others to see the progress and also areas for improvement.
Support and commitment from senior leadership is also a big benefit to the success of this project.
[Storyboard presentation at IHI's National Forum, December 2004]