Resetting theGoal: Strategies to Decrease Door to Reperfusion Time for ST Elevation MI Patients

Purpose:
Identify process improvement opportunities to further decrease the current 90 minute door to reperfusion time for STEMI patients to 60 minutes or less

Significance:
Having consistently met the 90 minute door to reperfusion time for ST elevation MI patients for the last 26 months, the STEMI Team focused on opportunities to consistently decrease the door to reperfusion time to less than 60 minutes to improve patient outcomes.

Strategy and Implementation:
Strategy and Implementation:
The STEMI team consists of nursing staff from the Emergency Room and Cardiac Cath Lab as well as the cardiovascular Clinical Excellence Manager and a pharmacist. All STEMI records are reviewed on a concurrent basis by the STEMI Team to identify process improvement opportunities, adherence to identified time stamp intervals, EKG findings, emergency room and cath lab processes, and patient outcomes. Rapid cycle process improvement strategies are developed to address identified improvement opportunities. Strategies that affect physician practice are discussed with the physician champion for the team and then presented at the monthly Cardiology and Emercency subsection meetings. Improvement strategies include overhead page for Code STEMI, field transmission of EKG, minimum patient data tool to decrease delay due to paperwork, and transfer of the patient to cath lab on EMS stretcher.

Evaluation:
Since resetting the goal in March 2010, our success rate for the 60 minute target was 52% (15/29) for the remainder of 2010. With continued evaluation and process improvement, the rate of door to reperfusion within 60 minutes was 71% (39/55) for 2011.

Implications for Practice:
Use of a multidisciplinary team to identify process improvement opportunities and develop strategies to address identified opportunities will lead to sustained improvement and positively affect patient outcomes.