Abstract P134: Creating and Sustaining a Reliable Door to Balloon Process: The VHVI Experience
| Autor: | Robert L Huang, Brittany Cunningham, David X Zhao, Robin Steaban, Thomas G DiSalvo |
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| Rok vydání: | 2011 |
| Předmět: | |
| Zdroj: | Circulation: Cardiovascular Quality and Outcomes. 4 |
| ISSN: | 1941-7705 1941-7713 |
| DOI: | 10.1161/circoutcomes.4.suppl_1.ap134 |
| Popis: | Background: Door to balloon time (D2B) ≤ 90 min reduces mortality in STEMI. Although many articles outline how to achieve a D2B ≤ 90 min, few address how to create a reliable D2B process longitudinally. Methods: We engaged in an institution-wide effort to yield iterative process and outcome improvement in D2B performance since 2006. A multidisciplinary team of ER physicians, interventional cardiologists, catheterization lab and ER nurses, hospital administrators, and emergency medical technicians (EMT) met monthly to redesign processes and systems and to review individual cases within 24 hours and aggregate data (monthly and yearly). Individual and aggregate case reviews interviewed EMTs, nurses, and physicians to capture specific clinical details in each case and employed statistical process control (SPC) charts to identify intervals of delay. Major outcome measures were total D2B time and % of patients with D2B ≤ 90 min. Results: From 2006-2009, our annual median D2B times were 75 min (n=11), 69.5 min (n=34), 65.5 min (n=38), and 55 min (n=49), respectively. Using an SPC proportions (p)-chart, we followed the performance of our system graphing the % of patients with a D2B ≤ 90 min. From 7/2006-4/2008, our process showed variation with regard to reliability despite improvement in median D2B. However, from 6/2008-1/2010 (19 months), we have achieved 100% reliability demonstrated on the p-chart. Conclusions: A sustainable D2B process can be achieved by a team of multidisciplinary stakeholders, iterative process redesign and SPC charts for individual and aggregate case review. Using SPC p-chart methodology, we achieved a higher level of reliability and performance. |
| Databáze: | OpenAIRE |
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