TEAMWORK YIELDS PERFECT EVIDENCE BASED CARE IN ACUTE MYOCARDIAL INFARCTION, CONGESTIVE HEART FAILURE AND PNEUMONIA

Purpose:
Duke Raleigh Hospital (DRAH) emergency room's mission is to provide perfect evidence based care (EBC) by supporting the Centers of Medicare & Medicaid Services' (CMS) indicators for healthcare delivery for patients diagnosed with Acute Myocardial Infarction, Congestive Heart Failure and Pneumonia.

Significance:
In April 2007, DRAH reported AMI 33%, CHF 67% and PN 75% for CMS. The reflection to the public, DUHS and CMS was that of sub-standard care. Assessment revealed challenges in the emergency room to which immediate solutions were necessary to create the excellent patient outcomes expected.

Strategy and Implementation:
Beginning in April 2007, nurses and doctors separately studied respective EBC requirements then attempted to adjust practice to become compliant. Because significant improvement was not being reported, the Nursing Department, in February 2009, initiated support of an EBC nurse who developed a checklist on which the direct care nurse could document medical and nursing EBC. Scores increased initially but vacillated as the checklist proved too time consuming. In October 2009, DRAH financially approved and appointed a nurse as EBC coordinator and a doctor as liaison, centralizing EBC assessment and follow through. Using Frankel's learning style assessments and Armellino's staff empowerment framework, the nurse coordinator and doctor liaison worked beside the emergency room medical and nursing management, to focus education on EBC requirements, communication and respect, to support cooperative medical and nursing EBC. While seemingly simple, the outcome was profound.

Evaluation:
Staff unification resulted in EBC reminders being communicated between medical and nursing staff. Within three months, EBC scores as measured by CMS began to measure 100%. From October 2009 – February 2010, scores showed significant improvement, leading to 100% from March 2010 through March 2011.

Implications for Practice:
Administrators must commit to expenses related to the delivery of perfect EBC. Results show that education empowers providers to routinely and collaboratively perform EBC. Consumers benefit through excellent patient outcomes and Duke retains its reputation as a provider of excellent health care.