Working Together to Improve ST-Elevation Myocardial Infarction Care: Beyond the Cath Lab

Purpose:
The overall goal of this project was to improve time to recognition of ST-Elevation Myocardial Infarction (STEMI), early activation of the cardiac catheterization laboratory staff, throughput of the patient from arrival in the Emergency Department (ED) to the cath lab, and ultimate reperfusion time.

Relevance/Significance:
Timely recognition and treatment of patients experiencing ST-Elevation Myocardial Infarction is critical to saving lives. Successful outcomes are dependent on multiple professionals both within the organization and the community working together in the best interest of the patient. To consistently achieve timely reperfusion, this nurse-led team focused their attention on community education, community partnerships, and throughput solutions.

Strategy and Implementation:
Based on reporting metrics, clinical nurses identified overall care of STEMI patients as an opportunity for improvement. Working together across departments and within the community, a performance improvement task force was formed in 2012. The team focused on community education to stress the importance of calling 911 if experiecing symptoms of a heart attack. They partnered with Emergency Medical Services (EMS) and acquired a LifeNet system to improve recognition, transmit electrocardiograms prior to arrival, and increase field activation of STEMI. Interdepartmental and interprofessional teams worked together using process improvement methods such as lean methodology and mock drills to improve throughput and shave critical minutes from arrival in the ED to arrival in the cath lab.

Evaluation:
Over a two year period, patients arriving by EMS increased from 59% to 67%. Field activation of the STEMI team increased from 75% to 93%. Average time from arrival in the ED to the cath lab decreased from 42.5 minutes to 33 minutes. The organization has outperformed the national database mean for percutaneous coronary intervention within 90 minutes of arrival for the past eight quarters.

Implications for Practice:
Nurses who are informed and engaged are drivers of improved outcomes. In this nurse-led performance improvement initiative, nurses provided the motivation and impetus for sustained change that led to significant improvements in the quality, effectiveness, and efficiency of STEMI care.