Middletown team refines its system
March 1, 1998 2 minutes read
Middletown team refines its system
Door-to-needle time cut from 84 to 22 minutes
Five years ago, a team at Middletown (OH) Regional Hospital set out to improve the treatment and outcomes of their AMI patients. Today the facility has accomplished these goals:
• Length of stay decreased from 4.9 days to 3.3 days.
• AMI mortality rates decreased from 10.9% to 6.5%.
• The percentage of patients discharged on aspirin increased from 24% to 55%.
• Pathways and protocols for chest pain, heparin use, and AMI orders were developed. (See chest pain pathways, pp. 47-48.)
• Beta blocker utilization improved.
• Door-to-needle time effectively decreased from an average of more than 84 minutes in January 1993 to 22 minutes in April 1997.
• The timing, quality, and interpretation of EKG and repeat EKG processes improved.
• The turnaround time for laboratory test results improved.
• Education on AMI identification and treatment was initiated for all EMS areas.
• Smoking cessation education was initiated.
"This project involved many different teams," says Jenny Stoops, director of quality management at Middletown, "because it evolved from our performance improvement program." Prior to the initiative, Middletown had in place a traditional quality assurance process. But to accomplish a systematic, organizational approach to improving care, the staff had to break the process down into microprocesses. They selected the following indicators to measure key aspects of ongoing processes and services:
• numbers of AMI patients receiving and not receiving thrombolytic therapy;
• median door-to-drug time;
• aspirin, beta blocker, and heparin use;
• mortalities;
• strokes and other adverse outcomes of lytic therapy;
• lengths of stay;
• EKG data and interpretation accuracy in the ED;
• other related measures, including:
utilization, appropriateness, and quality of nuclear cardiology;
interpretation turnaround time for reports and EKGs;
timing, utilization, and outcomes of catheterization and rehabilitation.
Hospital Case Management asked Carol Turner, RN, vice president of clinical and information services at Middletown, how they were able to improve aspirin, beta blocker, and heparin use.
"The way to sway the medical staff is to show them improved outcomes with their patients," she says. "We focused educational efforts on aspirin use and were able to demonstrate a difference in the outcomes after long-term use." The team worked with the EMS squads to get aspirin initiated in the field and talked about the use of beta blockers to all physicians treating AMI patients. After providing feedback on their performance as compared to others in the section, they modified their behavior. The team produced report cards for cardiologists and attendings that kept them up to date on AMI outcomes. The reports detailed returns to the ED, readmits, length of stay, and cost per case.
For more information about the AMI pathway, contact Carol Turner, RN, vice president of clinical and information services at Middletown Regional Hospital, 105 McKnight Dr., Middletown, OH 45044. Telephone: (513) 424-2111.
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