• Door-to-Balloon Time (in minutes)

• Conducted a drill-down inquiry of the door-to-balloon process. Each portion of the process was examined with respect to elapsed time and opportunities for improvement.
• Conducted weekly meetings with Catheterization (Cath) Lab, Quality Department, and ED Teams reviewed results of drill-down inquiry and discussed any problems, why they occurred, and opportunities to remedy them. Summaries of reviews were sent to the Chief Executive Officer and senior level administration.
• “Code STEMI*” box contents were adjusted to include:
  • Bags for lab tubes labeled “Code STEMI”
  • An exchangeable drug box that pharmacy will replace after each use
  • Updated consent forms
  • Cath lab Zoll pads

[*STEMI is a particular and common type of myocardial infarction in which the ST segment on the EKG is elevated. The hospital has an average of 10 cases per month.]

• Cardiovascular team established shorter expected response times from on-call cardiologist. Algorithm/tracking forms were revised to communicate expectations for cardiology response and provide a decision tree that expedites patient’s transfer to the Cath lab. 
• Senior leaders fostered assurance that the right people would be available to avoid bottlenecks. Agreements with Cardiology, ED physicians, and administration specified response times for cardiologist availability and assured that their presence would not cause a delay.

• Lack of communication with new staff members and/or physicians led to inconsistent results. Assure that new people with pivotal roles in the process know exactly what they must do.
• The commitment from senior leadership is vital to ensure ownership by all parties.  They brought the cardiologists into the process, and now review results at monthly meetings and provide any needed administrative support.

Debbie Stubblefield, RN
Director of Emergency Services
Baptist Memorial Hospital–DeSoto 
Debbie.Stubblefield@BMHCC.org