Discussions with the clinical site mentor about the actual performance of an organization have shown that primary angioplasty is much more effective in comparison with thrombolytic therapy when it comes to evaluating STEMI. It was also concluded that short door to balloon times dramatically improve the outcomes of primary angioplasty (PCI). My mentor, the Cardiovascular Lab (CVL) Director, mentioned that the door to balloon time of ninety or less minutes has often been associated with the smaller size of infarct, a better chance of long-term survival, as well as fewer adverse cardiovascular consequences (Mehta et al., 2009). Therefore, there is a strong and significant relationship between in-hospital mortality and door to balloon times, so there is a high need in enhancing the performance of a healthcare organization in order to improve patients’ health outcomes.
Reduction of Door to Balloon Time
While it has been agreed that the decrease in the door to balloon time can be achieved by creating a compliant-based cardiac triage protocol and streamlining ECG completion (Coyne et al., 2015), one of the key barriers to accomplishing the set goal persists. My mentor has identified the issue of budgeting as the main limitation that does not allow the facility to revamp its performance and reduce door to balloon time for improving patients’ health outcomes. Moreover, with the stable financial support for the organization, the implementation of the specified STEMI protocols will be achieved easily.
The budget of the organization is divided into different areas for making sure that there is enough funding for the majority of services. However, while the organization pays great attention to updating equipment and paying employees, there is a lack of financial support when it comes to training medical personnel. Since the improvement of the door to balloon time greatly depends on the skills of the staff that provides emergency help, it is crucial to invest in training and professional development.
The organization’s management recognizes that providing increased financial support to departments such as cardiovascular labs is important; however, it does not see the point in investing in people instead of equipment. After all, the human factor is one of the key components of developing a coordinated system of care for STEMI patients (Nestler et al., 2008). Furthermore, my mentor mentioned that the department is often updated with new equipment and technologies, which are unfamiliar to many employees. The time spent on adapting to new equipment is too precious, and it could have been spent on saving lives and helping STEMI patients. Thus, it can be proposed to cut investments into new technologies and equipment and to put a focus on training employees. They should know how to use newly introduced technologies as well as participate in developing a cohesive action plan for reducing the door to balloon time.
Budgeting Plan
It has been indicated that the capital budget of cardiovascular labs increases with a grandiose pace while the number of procedures is flattening (Fratt, 2007b). Only the smart cath lab management can handle the change and employ a broad number of strategies to increase the effectiveness of the provided services. Therefore, a budget plan should be developed in order to decrease door to balloon time and make sure that the funding is distributed evenly.
- Stop investing in “cookie-cutter equipment.” Since the majority of cath labs have the same imaging equipment, it is a smart idea to put the funding towards acquiring special equipment that will help in performing coronary, peripheral vascular, and EP procedures (Fratt, 2007b).
- Smart management. Because of the increased competition between the different cath labs, the budget plan can take a smart management approach that treats the provision of medical procedures as a business. By adapting to the changes and investing into staff training and planning for the future, the cath lab will see a significant increase in its performance.
- More IT. Because the cath lab technologies change at a rapid pace and because the medical staff has to adapt to the changes, it is crucial to engage the IT personnel into changing the templates, updating documentation requirements, and optimizing the entire process to save the precious time of the medical staff.
- More budgeting for training. The reduction of the door to balloon time does not only require a technological solution (Fratt, 2007a) but also a smart funding program that will invest into personnel training.
- Compromise. Make financial choices in accordance with what the cath lab needs as opposed to what it would have liked to have (Hoag, 2015). The most of the budget should be consumed by those investments that will directly benefit the reduction of the door to balloon time and the improvement of the overall performance of the cath lab.
To conclude, planning a budget for a cath lab in order to reduce door to balloon time is a task that requires experience on the part of the management. It is important to only invest in those areas that will have a direct impact on the performance of the medical personnel and provide them with growth and development opportunities.
References
Coyne, C., Testa, N., Desai, S., Lagrone, J., Chang, R., Zheng, L., & Kim, H. (2015). Improving door-to-balloon time by decreasing door-to-ECG time for walk-in STEMI patients. West J Emerg Med, 16(1), 184-189.
Fratt, L. (2007a). Strategies to trim door-to-balloon time.
Fratt, L. (2007b). The cardiac cath lab in evolution.
Hoag, H. (2015). Lab budgets: a number game. Nature, 524, 127-128.
Mehta, S., Oliveros, E., Alfonso, C., Falcao, E., Shamshad, F., Flores, A., & Cohen, S. (2009). Optimizing door-to-balloon times for STEMI interventions – Results from the SINCERE database. Journal of Saudi Heart Association, 21, 229-243.
Nestler, D., Noheria, A., Haro, L., Stead, L., Decker, W., Scanlan-Hanson, L.,…Lennon, R. (2008). Innovations in care: Sustaining improvement in door-to-balloon time over 4 years. Circulation: Cardiovascular Quality and Outcomes, 2, 508-513.