119

73 7768

48

2006 2007 2008 2009 2010

• “ CODE STEMI” Core Strategies are:

– Empowerment to the ED staff to call a “Code Stemi”

– Physician commitment

– One call activates the Cath Lab

– Cath Lab team ready in 30 minutes

– EKG within 5 minutes

– Prompt data feedback

– Senior management commitment

– Team-based approach

Chest Pain Center“CODE STEMI”

Emergency Department Director/ MD

Cardiology Medical

Director

Cardiac Cath Lab Quality DepartmentEMS

Key success factor!

• Clearly define • Clearly define Roles and

Responsibilities.

• Concurrent data collection.

Patient Sticker

Date:

STEMI Acute MI Worksheet

ED staff to fill in this area:

Checklist Labs (Check if drawn & sent; Print results if available.)

Informed Consent Signed CK-MB Na

Supplemental Oxygen Troponin K2 Peripheral IV's with 0.9NS WBC BUN

Hgb Cr

Pregnancy test result (pre-menopausal female) PLT INR

Time Line - Fill in military times only

To accomplish this, a patient needs to be sent to the cath lab within approximately 60 minutes after they arrive.

Early cath lab team notification is essential in achieving this goal!

Reasons for delaysEMS TRUCK NUMBEREMS TIME TO PATIENTEMS TIME TO ER

The following times are to be entered by the ED staff:

Symptom OnsetArrival to ED

Initial EKG performedSTEMI team contacted

Time Cath Lab called for patient

The following times are to be entered by cath lab:Arrival of Cath Lab TeamArrival of InterventionalistArtery accessPt. ready for PCITime wire is across lesionTime artery openTime procedure completed

Please describe any additional factors that delayed process:

• Debriefing for all CODE STEMI’s

Metric Process Owner

CP1 Claudia Santoyo, RN

Emergency Department

CP2 Eva England, RTR

Cath Lab/IR Manager

CP3 Claudia Santoyo, RN

Emergency Department Charles Bareis, MDEmergency Department

CP4 Erika Hernandez, RN

Cardiology Department

CP5 Daniel Butterbach, MD

Emergency Department

Medical Director

CP6 Daniel Butterbach, MD

Emergency Department

Medical Director

CP7 Kishin Ramani, MD

Cardiologist

Charles Bareis, MDChief Medical Officer

Ben Yedor, RNEMS Coordinator

• Rapid PDSA cycles

MacNeal Health Network

CODE STEMI QUALITY REVIEWS - 2009(ONLY CODE STEMI)

Performance Improvement Outcomes Tracking Form

Department Name: Emergency Department and Cardiac Cath Lab

1st Quarter

2nd Quarter Precentage

CODE STEMI CALLED 10 9 10 29

ACTUAL CODE STEMI'S 4 4 4 41.38% 100%

CANCELLED CODE STEMI'S 0 2 6 28%

CODE STEMI'S MISSED 0 0 0 0%

PT WITH EMS 7 6 7 68.97%

CODE STEMI CALLS FROM THE FIELD 1

INHOUSE CODE STEMI 1 0 0 3.45%

WALK INS 3 3 3 31.03%

Indicator/CriteriaGoal/Base

lineJan Feb Mar Total Apr YTD AVG

OVER/UNDER

BASELINE

Door to Open (ED and CCL combined) 90 54.5 40.6 55.75 50 50 40

Arrival in ED to CCL Ready (ED Time) 50 26.5 9.66 20 19 19 31

Door to EKG (ED Time) 10 1 1 3.75 2 2 8

CCL Contact to CCL Ready (CCL Time) 35 22 8.3 15.5 15 15 20

CCL Ready to Patient Arrival in CCL (ED and CCL combined) 10 9.75 13 11 11 11 -1

Arrival in CCL to Open Artery (CCL Time) 30 18.75 13.3 24.75 19 19 11

Arrival in CCL to Artery Access (CCL Time) 10 6.5 4.6 6.75 6 6 4

Artery Access to Artery Open (CCL Time) 15 11.75 13.3 18 14 14 1

119min 63 min 9min 63min 13min 32min 13min 19min

2006 Average “Door to Balloon” Time = 119min

• Continue to meet and review data every 2 weeks

Door To

open

50 min 19 min 2 min 15 min 11 min 19 min 6 min 14 min

ED toCCL

Ready

Door -EKG

CCL Readyto PatientArrival in

CCL

Arrival to CCLOpen Artery

Access

CCLContact –

CCL Ready

Arrival inCCL

Artery Access

ArteryAccess-Artery Open

2010 Average “Door to Balloon” Time = 50 min

119min 63 min 9min 63min 13min 32min 13min 19min

Celebrate our Successes

• EMS Dinners

• Internal communications• Internal communications

• Survivor meetings

• Excellence Award

EXCELLENT AWARD!CODE STEMICODE STEMI-- 28 min28 min

TIME IS MUSCLE!!!!!!!!!!!!!!ED: DR.__BUTTERBACH__;_KAREN, RN__;_SARA, RN_:ZACH, TECH

EMS: __CHICAGO FIRE______CARDIOLOGIST: DR.______BANE_____MD

CATH TEAM: ___CLAUDIA___;__ELLIE_____;_ EVA______DOOR TO ECG: _1__min (GOAL 10 MIN)

ECG TO CODE STEMI: _2__min (GOAL 10 MIN) DEPART ED TO CCL ARRIVAL: 5 min (GOAL 10 MIN)

CCL ARRIVAL TO OPEN ARTERY: _14 min (GOAL 30 MIN)

PRE POST

Going the extra mile.

• Calling the EKG from the Field

• Bi-Annual CODE STEMI drill

• Medical Simulation Research (ACC/Western Michigan University)

• Community Outreach

• EMS to open in 60 Minutes