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Door to Balloon Times: How we got to where we are

Door to Balloon Times: How we got to where we are. Brittany Cunningham, RN, MSN VHVI Quality Consultant July 27 th , 2011. Disclosures. Background. Annually close to 400,000 people suffer from a ST-elevation myocardial infarcation

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Door to Balloon Times: How we got to where we are

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  1. Door to Balloon Times: How we got to where we are Brittany Cunningham, RN, MSN VHVI Quality Consultant July 27th, 2011

  2. Disclosures

  3. Background • Annually close to 400,000 people suffer from a ST-elevation myocardial infarcation • In 2004, the median time to percutaneous coronary intervention (PCI) was 293 minutes, according to The Joint Commission.

  4. Historical Timeline

  5. Terminology Door-to-balloon time (D2B) is a measurement in emergency cardiac care, specifically in the treatment of STEMI. The interval starts with the patient's arrival in the emergency department, and ends when, in the cath lab, a catheter crosses and opens the blockage utilizing a balloon.

  6. Signs/ Symptoms • Chest Pain • Shortness of Breath • Nausea • Vomiting • Palpitations • Sweating • Anxiety (impending doom) • Indigestion • Weakness • Fatigue • “silent”

  7. D2B Alliance Joined a D2B Alliance in 2006 with over 1000 institutions which developed 6 key measures + 1 additional optional measure for success: • ED Physician activates the cath lab • Single-call activation system activates the cath lab • Cath lab team is available within 20-30 minutes • Prompt data feedback • Senior Mgmt commitment • Team-based approach • Prehospital 12-lead ECG activates the cath lab (optional)

  8. Multidisciplinary team • ED management • Educators from all areas • Quality Staff • CVICU management • VHVI administration • NFD administration • VHVI physician leadership • Interventionalists • Cathlab administration • Cathlab management • ED cardiologist • Pharmacist • ED Medical Director • ED administration • Cathlab Medical Director • Heat station manager • Life Flight Representative • VHVI Quality Consultant • General Cardiologist • Staff from all areas

  9. Chest Pain=Immediate ECG (10 minutes or less) for: • Any patient who presents to the ED with: • Non-traumatic chest discomfort > 30 years old (all patients with a history of recent cocaine use) • Pressure/aching/tightness/heaviness • Burning • Sharp/stabbing/pleuritic • Any patient with a recent history of having a coronary stent placed • Chest discomfort prior to arrival • Shortness of breath • Non-traumatic arm or shoulder pain • Beware atypical symptoms: • Diaphoresis • Dizziness, syncope/near syncope • Palpitations • Nausea > 50 Years Old • Epigastric pain >50 years old • Weakness > 50Years Old • Altered mental status or any symptom you think might be cardiac in origin Must have an immediate EKG performed and reviewed by an ED attending!!!!!

  10. Streamlined Process

  11. Clear definitions/ time stamps

  12. Individual Case Review within 24-48hrs

  13. Continuous Monthly Review

  14. SPC charts to identify interval delays

  15. SPC charts to identify interval delays Mean=7.58 Mean= 3.85

  16. SWAT Team Implementation CVICU Charge Nurse On-Call Cardiology Fellow ED Nurse Cathlab RN Cathlab Procedure Tech Interventional Fellow Interventionalist

  17. Questions?

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