Lean Six Sigma Process Improvement for ST Elevation Myocardial Infarct in a Rural Community Hospital Emergency Room

Purpose:
The process for the management and transfer of patient presenting with ST segment elevation MI from Corning Hospital, a community hospital without interventional services, to facilities with interventional cardiology was not effective. Lean Six Sigma was used to improve this process.

Significance:
The previous practice failed to meet the customer, core measures and AHA requirements with a door to door time was m=78 minutes sd= 56 minutes. The process was not capable of providing patients with first or second line recommended interventions for STEMI, contributing to inferior patient outcomes.

Strategy and Implementation:
Lean Six Sigma methodology was used to identify quality improvements to be implemented to develop a system of care using an interdisciplinary and multi agency approach to improve the end patient outcomes, minimize strains on the rural community hospitals' resources and build a system of care. A Kiazen event held with the team of subject matter experts from nursing, ancillary, medical, ground and air medical transport staff that work front line. Recommendations implemented eliminated no value added steps and sources of waste. Standard work is now foremost in the process within the two state healthcare systems which included to hospitals. Repeated education, drills and failure modes and analysis were used to develop a system of controls for the new process. An interdisciplinary team continues to review cases, education and maintain communication between frontline staff from multiple facilities and agencies.

Evaluation:
Post implementation of the Corning Hospital STEMI alert door to door time is m= 47 SD= 15, and no value added steps decreased from 18+ to 0. Continuous statistical analysis of the process will remain with process capabilities sigma level increase predicted at one year post implementation.

Implications for Practice:
The improved process decreases mortality and morbidity for patients with STEMI. The LSS methodology utilizes front line staff to develop quality improvements resulting in a nursing driven process within a system of care. Nursing lead change increases staff satisfaction and long term retention.