Two Hospitals-One Heart: World Class Heart Care through Multi-Disciplinary Collaboration

Purpose:
This presentation describes an innovative approach with cycles of refinement that has allowed integration of processes between two Magnet Hospitals, one with intervention capabilities and one without.

Significance:
See how top decile patient outcomes are obtained through the development of a streamlined ST-Elevation myocardial infarction process from Emergency Medical Services (EMS)ssessment through intervention.

Strategy and Implementation:
Results of a recent study by Dr Jeph Herrin (Yale University) published in the Archives of Internal Medicine concluded that patients requiring transfer to tertiary care for percutaneous coronary intervention (PCI) rarely met the recommended door-in to door-out (DIDO) time of 30 minutes or less. Dr. Tracy Wang's (Duke University) publication showed that mortality can be greatly reduced among non-PCI facilities that reduce DIDO to less than 30 minutes. Dr. Wang's study found that DIDO times in less than 30 minutes are achieved in 11% of ST-elevation myocardial infarction (STEMI) cases. Dr. Wang also found that STEMI patients with DIDO of greater than 30 minutes had in-hospital mortality of 5.9% compared to in-hospital mortality of 2.7% for patients with DIDO of less than 30 minutes. Through the use of process mapping, application of LEAN principles, and use of simulation, two Magnet hospitals were successful in reducing their DIDO from a 2010 mean of 53 minutes to 17 minutes in 2011.

Evaluation:
This reduction of DIDO time by 68% from the non-PCI facility has contributed to an overall door-to-balloon time consistently under the 90 minute benchmark, with an average of 79 minutes in 2011, including a 26 mile ambulance transfer between facilities.

Implications for Practice:
This presentation will highlight past attempts at improvement, process steps implemented to obtain the current status, and future planned cycles of refinement.