Improving STEMI Care: Reducing Door-to-Balloon Time at Kendall Regional Medical Center

Cardiovascular diseases are one of the primary causes of mortality among patients in the United States (Wilson et al., 2013). Kendall Regional Medical Center in Miami, Florida, provides high-quality cardiac health services for different groups of patients, including ST-Segment Elevation Myocardial Infarction (STEMI) patients. This group of patients is the most vulnerable, and they expect medical aid to be provided as quickly as possible (Coyne et al., 2015; Ellahham, Aljabbari, Mananghaya, Raji, & Al Zubaidi, 2015). Currently, the STEMI time (the door-to-balloon time) at Kendall Regional Medical Center is about 60 minutes.

The purpose of this quality improvement project is to implement a strategy that will decrease the center’s door-to-balloon time to 45 minutes. Such a decrease in wait time is necessary to address the high risks of complications, adverse effects, and deaths caused by delays in delivering care and support (Wilson et al., 2013). This brochure provides a summary of the education and communication plan to share the results of the quality improvement project; presents a timeline and steps to complete; and discusses the role of resources, technology, and staff in developing the project

Education and Communication Plan

Communication Objectives

The main objective of this communication plan is to provide stakeholders with opportunities to receive information about the quality improvement project on time. Furthermore, it is important to educate stakeholders regarding the expected changes in the work of the emergency department at Kendall Regional Medical Center.

Target Audience

1. members of the interdisciplinary team focused on developing the project;
2. staff;
3. patients and their relatives;
4. investors;
5. representatives of the community.

Format

1. meetings for the interdisciplinary team;
2. PowerPoint presentations;
3. brochures and flyers;
4. informative e-mails;
5. posts on the organization’s website.

Type of Information

Status reports and messages regarding the latest changes, results, and achievements.

Frequency

Weekly for six months.

Required Resources

To change the work processes in the emergency department and decrease the STEMI time, it is necessary to employ the following types of resources:

1. Human resources (nursing and medical staff, cardiologists, quality control specialists, HR managers) (Thilo, Blüthgen, & Von Scheidt, 2013).
2. Financial resources (investments, funding).
3. Technology (computers, tablets, EHRs, software) (Menees et al., 2014).
4. Equipment for the emergency department.

Timeline for Implementation Plan

The project is planned to be completed after six full months (24 weeks). The following timeline should be adhered to to implement the change according to the plan:

Role of Technology

Technology will play a key role in the process of implementing the project and evaluating its results. Indeed, it is important to provide nurses and practitioners with EHRs and tablets to guarantee that they can exchange a patient’s information quickly and examine his or her disease history to make the most appropriate decisions in concrete cases (Coyne et al., 2015). Furthermore, it is important to note that Kendall Regional Medical Center needs to buy more electrocardiography (ECG) machines to ensure that all STEMI patients can receive assistance and testing in time (Shiomi et al., 2012). As a result, it is possible to expect decreases in the door-to-balloon time.

Engaging Staff and Leveraging Creativity

The successful implementation of the project according to the set plan will only be possible when all members of the interdisciplinary team cooperate to achieve higher results. The purpose of the project is to execute the change at Kendall Regional Medical Center and improve outcomes for STEMI patients. Therefore, the staff should be motivated to participate in the project while focusing on achieving a goal that is important not only for healthcare facilities, patients, and staff but also for the whole community.

To engage the staff and leverage the employees’ creativity, the following strategies are proposed to be used: 1) brainstorming sessions; 2) training and team-building activities to improve cooperation; 4) staff participation in revising plans for project stages and evaluating project results; 5) the adoption of a system of bonuses for presenting creative ideas; and 6) the distribution of rewards for the successful realization of the project stages.

Project Steps

A series of steps should be completed to realize the quality improvement project effectively:

1. the formation of a working interdisciplinary team;
2. the formulation of the project mission and goals;
3. the selection of specific strategy to implement (to create the change of processes in the emergency department);
4. the planning of the project stages and activities;
5. the initiation of an improved hiring process;
6. the provision of training and education for the staff;
7. the completion of project tasks;
8. and the evaluation of results and achievements.

These steps are designed to complete the project goals and achieve positive changes in the process of delivering care to STEMI patients.

References

Coyne, C. J., 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. Western Journal of Emergency Medicine, 16(1), 184-189.

Ellahham, S., Aljabbari, S., Mananghaya, T. H., Raji, S. J., & Al Zubaidi, A. (2015). Reducing door to-balloon-time for acute ST elevation myocardial infarction in primary percutaneous intervention: Transformation using robust performance improvement. BMJ Quality Improvement Reports, 4(1), 1-8.

Menees, D. S., Peterson, E. D., Wang, Y., Curtis, J. P., Messenger, J. C., Rumsfeld, J. S., & Burm, H. S. (2014). Door-to-balloon time and mortality among patients undergoing primary PCI. Survey of Anesthesiology, 58(4), 162-163.

Shiomi, H., Nakagawa, Y., Morimoto, T., Furukawa, Y., Nakano, A., Shirai, S.,… Mitsuoka, H. (2012). Association of onset to balloon and door to balloon time with long term clinical outcome in patients with ST elevation acute myocardial infarction having primary percutaneous coronary intervention: Observational study. BMJ: Clinical Research, 344(1), e3257-e3257.

Thilo, C., Blüthgen, A., & Von Scheidt, W. (2013). Efficacy and limitations of a STEMI network: 3 years of experience within the myocardial infarction network of the region of Augsburg-HERA. Clinical Research in Cardiology, 102(12), 905-914.

Wilson, B. H., Humphrey, A. D., Cedarholm, J. C., Downey, W. E., Haber, R. H., Kowalchuk, G. J.,… Garvey, J. L. (2013). Achieving sustainable first door-to-balloon times of 90 minutes for regional transfer ST-segment elevation myocardial infarction. JACC: Cardiovascular Interventions, 6(10), 1064-1071.