Paper
Tuesday, November 15, 2005
Improving Door to Balloon Times of the St Elevated MI (Stemi) Patient: a Community Hospital and Regional Heart Center Collaborate to Create a Unique Transfer Process to Save Valuable Time & Muscle
Daniel G. Leshko, RN, CCRN, PHRN, University MedEvac, Lehigh Valley Hospital and Health Network, Allentown, PA, USA, Deborah Neff, RN, BSN, CCRN, Emergency Department, Blue Mountain Health System, Gnaden Huetten Campus, Lehighton, PA, USA, Jo Ann Wells, RN, MSN, Care Management, Lehigh Valley Hospital, Allentown, PA, USA, and Daniel Rymond, BS, University MedEvac, Lehigh Valley Hospital, Allentown, PA, USA.
| Learning Objective #1: Outline a strategic plan focused on improving transfer times between a local Community Hospital and a Regional Heart Center |
| Learning Objective #2: Discuss detailed benefits for the patient and organization of improving door to balloon times of patients with a STEMI |
Lehigh Valley Hospital and Health Network (LVHHN) and Gnaden Huetten Hospital (GHH), a community hospital 26 miles away, developed and implemented a unique transfer process to improve the treatment /outcomes for the confirmed ST Elevated Myocardial Infarction (STEMI) patient. This process reduces emergency department (ED) length of stay (LOS) at the GHH. The patient is transported rapidly and directly to the cardiac cauterization lab (CCL) at LVHHN. The end result has been a dramatic improvement in GHH door time to LVHHN balloon time. Defined criteria in a protocol and on the GHH Physician Orders put the process quickly into action for the STEMI patient. Acute medical management is started a with a single phone call to the LVHHN transfer center. The STEMI patient's treatment follows a standardized protocol at GHH and is immediately prepared for transfer to LVH. LVHHN's MedEVAC helicopter is dispatched to GHH and a CCL room is simultaneously prepared for the patient's arrival. If it is after regular lab hours a call team is paged and arrives within 20 minutes. Because of an intensive cooperative educational effort by the flight team and GHH ED staff, the patient's IV medications are already prepared on transport pumps, records are faxed to the CCL and X-rays are ready for transport. This allows for rapid departure from GHH's ED. The flight crew transports the patient directly to LVHHN's CCL. In a random retrospective review of patients that met the STEMI criteria prior to the process implementation were as follows. Pre protocol: GHH door time to LVH balloon was a mean time of 289.06 minutes with a median time of 164.5 minutes. After the process was initiated: times were drastically reduced to a mean time of 107 minutes and a median time of 105 minutes, door to balloon time. TIME IS MUSCLE!