Time is Muscle: Developing a New Reperfusion Goal

Tuesday, 13 July 2010

Cheryl Lynn Duncan, BSN, RN, CVN
Cardiac Catheterization Laboratory, Michael E. DeBakey VA Medical Center, Houston, TX
Lucy E. Lacy, BSN
Cardiac Catheterization Department, Michael E. DeBakey VA Medical Center, Houston, TX
Camille Dixon, MBA, MSN, RN
Cardiology Clinic, Michael E. DeBakey VA Medical Center, Houston, TX

Learning Objective 1: 1. Demonstrate an interdisciplinary collaborative effort to improve the door –to-balloon time less than 90 minutes.

Learning Objective 2: 2. Initiate a safe, timely and efficient patient throughput from the Emergency Center to the Cath Lab.

Cardiovascular Disease is the “Single Largest Killer” of people in the United States.   According to American College of Cardiology (ACC) and American Heart Association (AHA)  guidelines, the patient outcomes for ST Elevation Myocardial Infarction (STEMI) can be markedly improved with achieving the door-to-balloon time of <90 minutes. An interdisciplinary multi-unit collaborative work group was created to analyze and evaluate the door-to-balloon time process for STEMI patients.  Out of this work group, two major efforts occurred; the Heart Attack Team was created and a chest pain mystery shopper presented to the Emergency Center.
The initiative incorporated a group web-based paging system which allowed the EC doctor to activate the Heart Attack team without consultation with the cardiologist. The mystery shopper findings have resulted in alleviating avoidable barriers or delays.  Changes included an immediate (within 5 minutes) EKG once a patient enters the EC with complaints of chest pains.
The patients having an acute MI is rapidly processed through the EC using the AMI protocol (EKG with ST elevation, cardiac catheterization consent, ASA, oxygen, 2 large bore IV’s, and lab work.  The patient is rushed to the cath lab for a timely Percutaneuous Coronary Intervention (PCI).  On-call Cath Lab staff arrives within 30 minutes to the Cath Lab. The Heart Attack team is activated and the patient is transported to the Cath Lab within 30 minutes.  In FY 2003 door-to-balloon-time was approximately 202 minutes.  FY 2005 the mean was 144 minutes; in FY 2007 the mean was 66 minutes.  FY 2008 the mean was 84 minutes.  The door-to-balloon time currently is 57 minutes.