Completing the feedback loop to EMS and referring hospitals
Completing the feedback loop to EMS and referring hospitals
Completing the feedback loop to EMS and referring hospitals
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Utilizing Data To Drive The<br />
Process In STEMI Systems Of Care<br />
Julie Poppe, RN, BSN Cardiovascular Coordina<strong>to</strong>r
Oversight Committee<br />
Dr. Walder, Executive Direc<strong>to</strong>r of Cardiology<br />
Cardiology QA/QI Committee<br />
4 Cardiologists<br />
Monthly meeting<br />
Reviews all data<br />
Recommendations for Quality improvement<br />
Provides physician education
Concurrent Data Collection Process<br />
Clint Mollman<br />
Action GWTG<br />
PCI Registry<br />
Data Collection Process<br />
Concurrently collects data<br />
Immediate <strong>feedback</strong> <strong>to</strong> physicians<br />
Provides staff education
Process Improvement<br />
Julie Poppe RN, BSN<br />
Concurrent collection of STEMI data<br />
Provides STEMI <strong>feedback</strong> <strong>to</strong> <strong>referring</strong> facilities,<br />
physicians, nurses <strong>and</strong> <strong>EMS</strong><br />
Root cause analysis of STEMI process when times<br />
exceed 90 minutes<br />
Provides education<br />
Provides support <strong>to</strong> <strong>referring</strong> <strong>hospitals</strong><br />
Quarterly PCI Meetings
Action Registry<br />
Data is presented quarterly <strong>to</strong> Cardiac QA/QI,<br />
Cardiac Section <strong>and</strong> Cardiac PEC<br />
Provides benchmark data<br />
Core measure<br />
STEMI<br />
Door <strong>to</strong> EKG<br />
Door <strong>to</strong> Balloon<br />
Medication utilization
STEMI Feedback<br />
Feedback given <strong>to</strong> ED nurses, ED physician <strong>and</strong><br />
Cardiologist on case<br />
Tracking sheet given within 48 hours of case unless<br />
time exceeds 90 minutes<br />
Immediate <strong>feedback</strong> <strong>and</strong> root cause on all STEMI’s<br />
exceeding 90 minutes
STEMI Physician & Nursing Feedback<br />
Goals<br />
Stemi Tracking Sheet<br />
Admission Date: 11/20/2011<br />
Account Number:<br />
Time of arrival:<br />
10:22 AM<br />
Mode of arrival:<br />
Ambulance<br />
Physician<br />
ED Physician/Cardiology<br />
Time in Minutes Goal Met<br />
10 Min<br />
5 Min<br />
30 Min<br />
Arrival time <strong>to</strong> EKG<br />
EKG <strong>to</strong> Stemi Alert<br />
Activation<br />
Stemi Alert <strong>to</strong> Card<br />
Seeing pt.<br />
Card seeing pt <strong>to</strong><br />
departure from ED <strong>to</strong><br />
Cath lab<br />
Pre-Arrival<br />
Pre-Arrival<br />
On Arrival<br />
20 Min<br />
45 Min ED Time 20 Min<br />
Dep from ED <strong>to</strong> arrival<br />
in Cath lab<br />
10 Min<br />
45 Min<br />
Arrival <strong>to</strong> case start<br />
2 Min<br />
Case start <strong>to</strong><br />
reperfusion<br />
15 Min<br />
45 Min Cath Lab Time 27 Min<br />
90 Min<br />
Door 2 Balloon<br />
Time<br />
47 Min<br />
Goal Met<br />
Goal Not Met<br />
If you have any questions about your STEMI times please<br />
contact Julie Poppe Cardiac Program Quality Coordina<strong>to</strong>r<br />
at 719-2021 or 716-3989
STEMI Feedback<br />
Monthly report<br />
Includes all cases for <strong>the</strong> month<br />
Data is transparent<br />
Posted in <strong>the</strong> Emergency Room, Cath Lab <strong>and</strong> given <strong>to</strong><br />
all Cardiologists<br />
Data is presented at monthly Cardiac QA/QI meeting<br />
<strong>and</strong> Cardiac Section meeting
STEMI Feedback<br />
Goals<br />
10 min.<br />
Admission Date<br />
Pt Account Number<br />
Time of arrival<br />
Mode of arrival<br />
* = weekend<br />
Arrival Time <strong>to</strong> EKG<br />
5 Min<br />
30 min.<br />
45 min. ED Time<br />
45 min.<br />
EKG <strong>to</strong> STEMI Alert activation<br />
STEMI activation <strong>to</strong> Cardiologist<br />
seeing pt.<br />
Cardiologist seeing pt <strong>to</strong><br />
departure from ED<br />
Departure from ED <strong>to</strong> arrival in<br />
cath lab<br />
From arrival <strong>to</strong> cath lab <strong>to</strong> case<br />
start<br />
Case start <strong>to</strong> reperfusion<br />
45 min. Cath lab Time<br />
90 min. Door 2 Balloon Time<br />
ED Physician<br />
Noninterventionalist<br />
Interventionalist<br />
ED Staff<br />
Cath Lab Nurses/Tech<br />
Reasons for delay<br />
Pt Expired
Transfer STEMI’s<br />
Electronic <strong>feedback</strong> <strong>to</strong> <strong>referring</strong> facilities<br />
Thrombolytic education & <strong>feedback</strong><br />
Recommend all facilities give thrombolytics unless<br />
contraindicated<br />
Provide support as needed
STEMI Feedback<br />
Admission Date:<br />
Acct Number<br />
Transfer Stemi Tracking Sheet<br />
Goals<br />
Arrival time <strong>to</strong><br />
<strong>referring</strong> hospital<br />
Chest pain onset<br />
Did PT receive TNK<br />
Mode of arrival<br />
Transferring Hospital Time<br />
Arrival time <strong>to</strong> EKG<br />
(<strong>referring</strong> hospital)<br />
EKG <strong>to</strong> call <strong>to</strong><br />
transport service<br />
Arrival time <strong>to</strong> TNK<br />
Time of contact with<br />
Cardiologist<br />
Departure time from<br />
<strong>referring</strong> hospital<br />
Arrival time<br />
EKG Time<br />
Arrival time<br />
Card Time<br />
Arrival time<br />
EKG Time<br />
Alert Time<br />
TNK Time<br />
Dep Time<br />
Dep Time<br />
Time in Min<br />
Time in Min<br />
Time in Min<br />
Time in Min<br />
0:00<br />
Time in Min<br />
Notes<br />
Transferring Hospital<br />
Time<br />
0:00<br />
Departure time <strong>to</strong><br />
Arrival time at RCRH<br />
Dep Time<br />
Arrival Time<br />
Time in Min<br />
Notes<br />
Transport Time 0:00<br />
Arrival time <strong>to</strong> Cath<br />
lab departure time<br />
Arrival Time<br />
Dep Time<br />
Time in Min<br />
Notes<br />
PCI TIME<br />
Dep from ED <strong>to</strong> arrival<br />
<strong>to</strong> cath lab<br />
Arrival <strong>to</strong> cath lab <strong>to</strong><br />
case start<br />
Dep Time<br />
Arrival Time<br />
Arrival time Case Start<br />
Time in Min<br />
Time in Min<br />
Case start <strong>to</strong><br />
Reperfusion<br />
Case Start Reperfusion<br />
Time in Min<br />
90 Min<br />
Door 2 Balloon Time 0:00<br />
Total PCI Time 0:00<br />
Referring Hospital<br />
physician<br />
Noninterventionalist<br />
Interventionalist<br />
STAFF<br />
ED Staff<br />
Cath Lab Staff<br />
Reasons for Delay<br />
Patient Expired<br />
Notes:
STEMI Feedback<br />
Transfer STEMI Tracking Sheet<br />
Patient Received TNK<br />
Admission Date:<br />
Acct Number<br />
Arrival time <strong>to</strong> <strong>referring</strong><br />
Chest pain onset<br />
Did PT receive TNK<br />
Mode of arrival<br />
Transferring Hospital Time<br />
Arrival time <strong>to</strong> EKG<br />
(<strong>referring</strong> hospital)<br />
Arrival time <strong>to</strong> TNK<br />
Transferring Hospital<br />
Transport Time<br />
Cath Lab Time<br />
Arrival time <strong>to</strong> Cath lab<br />
departure time<br />
Case start <strong>to</strong> reperfusion<br />
D2 Needle Time<br />
Total Time<br />
Referring Hospital physician<br />
Noninterventionalist<br />
Interventionalist<br />
ED Staff<br />
Cath Lab Staff<br />
Reasons for Delay<br />
Patient Expired<br />
Transfer STEMI data is for your information only.<br />
Please contact Julie Poppe Cardiac Program Quality<br />
Coordina<strong>to</strong>r at 719-2021 if you have any questions or<br />
concerns.
<strong>EMS</strong> Feedback<br />
Feedback on individual cases<br />
<strong>EMS</strong> Direc<strong>to</strong>r<br />
Attends Quarterly PCI Meeting<br />
Annual education
STEMI Feedback<br />
Admission Date:<br />
Acct Number<br />
Transfer Stemi Tracking Sheet<br />
Goals<br />
Arrival time <strong>to</strong><br />
<strong>referring</strong> hospital<br />
Chest pain onset<br />
Did PT receive TNK<br />
Mode of arrival<br />
Transferring Hospital Time<br />
Arrival time <strong>to</strong> EKG<br />
(<strong>referring</strong> hospital)<br />
EKG <strong>to</strong> call <strong>to</strong><br />
transport service<br />
Arrival time <strong>to</strong> TNK<br />
Time of contact with<br />
Cardiologist<br />
Departure time from<br />
<strong>referring</strong> hospital<br />
Arrival time<br />
EKG Time<br />
Arrival time<br />
Card Time<br />
Arrival time<br />
EKG Time<br />
Alert Time<br />
TNK Time<br />
Dep Time<br />
Dep Time<br />
Time in Min<br />
Time in Min<br />
Time in Min<br />
Time in Min<br />
0:00<br />
Time in Min<br />
Notes<br />
Transferring Hospital<br />
Time<br />
0:00<br />
Departure time <strong>to</strong><br />
Arrival time at RCRH<br />
Dep Time<br />
Arrival Time<br />
Time in Min<br />
Notes<br />
Transport Time 0:00<br />
Arrival time <strong>to</strong> Cath<br />
lab departure time<br />
Arrival Time<br />
Dep Time<br />
Time in Min<br />
Notes<br />
PCI TIME<br />
Dep from ED <strong>to</strong> arrival<br />
<strong>to</strong> cath lab<br />
Arrival <strong>to</strong> cath lab <strong>to</strong><br />
case start<br />
Dep Time<br />
Arrival Time<br />
Arrival time Case Start<br />
Time in Min<br />
Time in Min<br />
Case start <strong>to</strong><br />
Reperfusion<br />
Case Start Reperfusion<br />
Time in Min<br />
90 Min<br />
Door 2 Balloon Time 0:00<br />
Total PCI Time 0:00<br />
Referring Hospital<br />
physician<br />
Noninterventionalist<br />
Interventionalist<br />
STAFF<br />
ED Staff<br />
Cath Lab Staff<br />
Reasons for Delay<br />
Patient Expired<br />
Notes:
Conclusion<br />
Cardiologists drive <strong>the</strong> process<br />
Concurrent data collection with immediate <strong>feedback</strong><br />
is <strong>the</strong> key <strong>to</strong> success<br />
Transparent data leads <strong>to</strong> rapid improvement<br />
Be visible <strong>to</strong> physicians <strong>and</strong> staff<br />
Julie Poppe<br />
jpoppe@reigonalhealth.com<br />
719-2021
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