Different groups among staff actively engage in the project’s success and should be included in the planned implementation of an organization change project reducing Door to Balloon (D2B) time for ST-Elevation Myocardial Infarction (STEMI) patients at Kendall Regional Medical Center. This paper considers how STEMI patients and their families, emergency department physicians, paramedics, emergency department, and STEMI team, influence the practicum project.
STEMI Patients and Their Families
Reducing D2B time starts with the patients and their families who reach emergency response services and initiate rapid therapeutic intervention (CCN, 2013). They are responsible for the provision of consent. Recent research shows that the in-hospital mortality rate for the patients who delayed in providing consent for the emergency PCI amounts to approximately 10 % (Swaminathan et al., 2013).
Moreover, patients who caused delays in providing consent for the procedure are more likely to be old, non-white, or female (Swaminathan et al., 2013). Therefore, families and patients themselves are responsible for the reduction of adverse effects caused by the postponement of emergency procedures (Swaminathan et al., 2013). The practicum change project might be greatly affected by the role of patients and their families.
Emergency Department Physician
The emergency department physician is responsible for the activation of the cath laboratory and urgent physical transfer of the STEM patient to the prepared by in-house nurses laboratory (Peterson, Syndergaard, Bowler, & Doxey, 2012). ED physician is typically assigned to the resuscitation area of the hospital for the whole shift. According to a recent study, D2B meantime can be significantly reduced when a cardiologist is directly consulted by the emergency department physician, rather than by internist (Peterson et al., 2012). The positive outcome of the change project depends on the contribution of the emergency department physician.
Paramedics
Trained paramedics can diagnose STEMI using a pre-hospital electrocardiogram (PH-EGG) and either transmit it to a hospital-based cardiologist or interpret it on-site, thus significantly contributing to successful pre-hospital STEMI management and reduction of D2B time (Cantor et al., 2012). However, advanced training is required for the successful performance of the triage of STEMI patients. Upon receiving such education, paramedics would be able to interpret 12-lead ECGs and initiate intravenous access (Cantor et al., 2012). The practicum change project might be greatly affected by the role of paramedics.
STEMI Team
The well-trained STEMI team can significantly reduce the time a patient spends in the ED and cath laboratory. Their clinical efforts are being coordinated by the hospital administration. The STEMI team consists of two CVL nurses and cardiovascular technicians, perfusions technician, and cardiology/cath laboratory team.
The successful implementation of the quality improvement policies has allowed to significantly decrease D2B time in the period between 2005 and 2009 (Menees et al., 2014). More than 80% of patients in the United States met the goal set by ACC-AHA guidelines for 90 minutes or less D2B time (Menees et al., 2014). Well adjusted and coordinated STEMI team plays a critical role in influencing the result of the change project (Menees et al., 2014).
Emergency Department
The emergency department (ED) is responsible for the registration, triage, consultation with the physician and cardiologist, ECG, and percutaneous intervention procedures. The changes during the ED phase can significantly influence the outcome of the change project and reduce D2B time in the case of primary PCI by up to 60 minutes (Lim, Wee, & Anantharaman, 2013). In the case of patients being transported to the ED in their vehicles ECG can be completed within 10 minutes, thus allowing emergency physicians to read it immediately (Lim et al., 2013).
References
Cantor, W., Hoogeveen, P., Robert, A., Elliott, K., Goldman, L., Sanderson, E.,… Miner, S. (2012). Prehospital diagnosis and triage of ST-elevation myocardial infarction by paramedics without advanced care training. American Heart Journal, 164(2), 201-206.
CCN. (2013). Recommendations for best-practice STEMI management in Ontario.
Lim, S., Wee, J., & Anantharaman, V. (2013). Management of STEMI. Curr Emerg Hosp Med Rep, 1(1), 29-36.
Menees, D., Peterson, E., Wang, Y., Curtis, J., Messenger, J., Rumsfeld, J.,… Burm, H. (2014). Door-to-Balloon Time and Mortality among Patients Undergoing Primary PCI. Survey of Anesthesiology, 58(4), 162-163.
Peterson, M., Syndergaard, T., Bowler, J., & Doxey, R. (2012). A systematic review of factors predicting door to balloon time in ST-segment elevation myocardial infarction treated with percutaneous intervention. International Journal of Cardiology, 157(1), 8-23.
Swaminathan, R., Wang, T., Kaltenbach, L., Kim, L., Minutello, R., Bergman, G.,… Feldman, D. N. (2013). Nonsystem Reasons for Delay in Door-to-Balloon Time and Associated In-Hospital Mortality. Journal of the American College of Cardiology, 61(16), 1688-1695.