Summary
This paper aims to generate a process for analysis of the data collected in previous works resulting in the concise and proper analysis and development of the data implementation into a workable plan. In order to create a comprehensible project, it seems appropriate to apply the table format.
A review of the data
The core concepts of the research are ‘time is muscle’ and the ‘golden hour theory’ that reveal the fact that time is the main decisive factor during the period of medical contact. First of all, the research focuses on determining the DTB in STEMI patients. After that, it was stated that there is a need for the enhancement of primary PCI. Hospital leadership is the first area to be improved as it plays a paramount role in change management. Besides, organizational and political issues such as the personnel training and action plan require improvement as well. Individualistic behaviors of the staff members should be eliminated in order to create an integrated team that would collaborate effectively. Moreover, one might note the necessity to develop the overall change strategy concerning all the vital issues connected to the topic. It is also should be pointed out that communication is one of the most significant aspects of the change plan, the appropriate implementation of which would promote cooperation as well as the decrease of the DTB in the STEMI patient.
The method of the research and rationale
The study applies a mixed design of the investigation. A qualitative method involves the collection of information in a free form received from physicians, administrators, and nursing staff; it focuses on the understanding, explanation, and interpretation of empirical data that is the source of speculation and productive ideas. A quantitative method comprises conducting various surveys based on the use of structured questions of closed type, which corresponds to a large number of respondents. The main objective of quantitative research is to obtain a numerical estimate of the issue or the reaction of respondents towards it. In particular, the study uses Mann-Whitney and Chi-square tests. Consequently, the quantitative representation would be accompanied by the qualitative explanation of the situation.
The rationale of the study is caused by the need to examine the issue of the DTB in STEMI patients and improve it to 45-60 minutes as the mortality rate from cardiovascular diseases remains high.
A process for analyzing the data
Among the resources that might help to analyze, develop, and implement the collected data, one might mention the Mann-Whitney U test. It is a nonparametric criterion and, in contrast to the Student t-test, does not require the normal distribution of the compared populations and would be used to represent and assess median periods. Therefore, the application of the above test seems rather relevant to the study.
The data analysis plan would also include the Chi-square test which is a method allowing to evaluate the significance of differences between the actual (identified by the study) number of outcomes or quality characteristics of the sample falling into each category and the theoretical amount that can be expected in the studied groups with the null hypothesis. In other words, it is a method evaluating the statistical significance of the categorical data of differences between two groups identified in the study.
In addition, it seems appropriate to use thematic analysis to analyze the qualitative data. It would reflect the current situation and help in developing the perspective action plan in the area of the hospital’s organizational culture.
A plan to integrate the data into the change project
According to the collected data, it seems important to use the concept of Lean as a Quality Improvement Tool to decrease the D2B time. Besides, the implementation of Six Sigma also contributes to the reduction of the D2B time. In addition, it is of great importance to developing special programs and procedures that would involve medical personnel stakeholders to collaborate and improve the reperfusion period. The awareness and the reaction space of the hospital should be increased to provide patients with timely emergency health care. According to Joost, Blumrath, and Radke (2012), “respective training of staff members lead to a significant reduction in DTB intervals” (p. 140). It was also stated that the STEMI receiving centers should work on a 24/7 basis and should be equipped with professional cardiologists (Savage, Raffel, Walters, & Gough, 2010). What is more important, in spite of ACC/AHA guidelines, it seems necessary to implement 45 to 60 minutes D2B. Stowens, Sonnad, and Rosenbaum (2015) state that using EMS dispatch to note STEMI patients decreases D2B intervals. According to the results of the study, the above measure was reduced lower than 60 minutes.
Before starting the change project, it is of great importance to evaluate the changing context. Precisely speaking, organizational, environmental, and readiness to change components should be assessed. A head nurse should complete the vision of the change plan along with its outcomes. After that, the change management should be considered taking into account objectives, resources, and staff training. Additionally, potential gaps and feedback should be considered.
References
Joost, A., Blumrath, C., & Radke, P. (2012). TCT-485 A simple strategy to significantly reduce the “door-to-balloon” time in patients with acute ST-elevation myocardial infarction. Journal of the American College of Cardiology, 60(17), 140-142.
Savage, M., Raffel, C., Walters, D., & Gough, C. (2010). Pre-hospital Ambulance Notification of ST-Elevation Myocardial Infarction (STEMI) Significantly Improves Door to Balloon Time (DTB) for Primary Percutaneous Coronary Intervention (PPCI)—Australian Setting. Heart, Lung and Circulation, 19(2), 244-245.
Stowens, J., Sonnad, S., & Rosenbaum, R. (2015). Using EMS Dispatch to Trigger STEMI Alerts Decreases Door-to-Balloon Times. Western Journal of Emergency Medicine, 16(3), 472-480.