In medicine, time is of the essence. It’s important that all are on the same page in terms of how quickly care should be provided. In urgent medical situations, speed of care could mean life or death.
STEMI (ST Segment Elevated Myocardial Infarction) is a type of heart attack. When emergency room patients are experiencing a STEMI, every moment lost could be detrimental to the patient’s health.
“A STEMI is a true medical emergency where the promptness of delivering appropriate therapy is clearly linked to clinical outcomes,” noted Dr. Rabeea Aboufakher, cardiology. It takes swift teamwork, from paramedic to emergency room staff and physicians to cardiologists and cath lab team, to ensure a positive patient outcome.
Our experts analyzed the processes related to STEMI patients and found we could improve in the area of PCI within 90 minutes of patient arrival at the hospital (PCI, or percutaneous coronary interventions, can refer to angioplasty, stenting or artherectomy). This is one of the 130 quality indictors continually reviewed for improvement at Altru.
As a result, a STEMI code was established. “Every minute is crucial,” shared Sandy Kovar, Altru’s STEMI and stroke coordinator. “Establishing this code allowed us to tighten up every aspect of the process.”
The team enlisted the help of a STEMI taskforce and Altru’s performance improvement coordinators. Together, they reviewed steps related to the code and identified ways minutes could be saved in one area and better used in another.
One of the largest successes was through emergency physicians now able to activate the STEMI code to quickly execute the remaining steps, bringing the patient to the cath lab for life-saving intervention.
“We’ve always taken good care of our patients. Yet, there’s always room for improvement,” stated CariAnn Dahlquist, quality improvement coordinator. “By adjusting processes, we’ve successfully dropped our time from arrival to PCI by 17 percent (first quarter 2012 average compared to first quarter 2013 average).” We continually seek ways to improve, so that STEMI patients can get from the emergency room to having their vessel open in under 90 minutes.
Emergency room staff have shared with Sandy that the process has become more organized. “They understand protocols and the sense of urgency. Everyone feels ownership. If there is an outlier that goes beyond our standard timeframe, we study each step of the process and make improvements.”
Engaging the help of performance improvement coordinators has brought a new perspective to the project. “We help identify the most effective use of resources. In this instance, the team found minutes saved in the emergency room could best be used in the cath lab,” noted Derek Goebel, performance improvement coordinator.
Providing high quality, safe care is always of the utmost importance for Altru.
Beyond that, reactions from patients and families have been positive. They see the constant communication between staff and are kept abreast of the situation.
“Staff will communicate with family members each step of the way to explain why there is a sense of urgency for taking care of their loved ones,” Sandy said. The team has replicated this process for another project related to establishing a Stroke Code, which went live on July 1, 2013.
Keep watching the blog for regular updates on how we are improving the quality of care our patients receive.