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CS193
Virtual CCU in the Emergency Department for STEMI Patient Care
By: Julie Benz, St. Anthony Central Hospital, Denver CO
For further information, please contact: juliebenz@centura.org
Background: The American Heart Association and the American College of Cardiology (ACC/AHA Guidelines for the Management of Patients with ST Elevation Myocardial Infarction, Circulation. 2004; 110) have defined the safest management of patients experiencing an acute myocardial infarction. This evidenced-based approach includes treatment plans, medications, techniques and timing of events that have been shown to improve patient outcomes.
Purpose: The purpose of this evidence-based project was to develop and implement a reproducible action plan for a Clinical Effectiveness Team (CET), led by a Clinical Nurse Specialist (CNS).
Methods: A diverse, multi-disciplinary CET was created to develop the strategies needed to reduce our “door-to-balloon” time. We encourage the identification of barriers to perfect care. Better methods and improved patient satisfaction included: a centralized beeper/paging system to announce the arrival of a patient in the emergency department, a designated team including a nurse from the Cardiac Intensive Care Unit which responds to the patient’s arrival, a prioritized nursing check-off list, and a reduction in the number of hand-off reports.
Results/Outcomes:
These strategies reduced our “door-to-balloon” times from a median of 142 minutes to a median of 66 minutes and 77 minutes (2006) at our two facilities. The strategies have placed our compliance with other nationally-recognized quality indicators in the top 1% of all facilities caring for patients with acute myocardial infarctions. The American College of Cardiology rated the program 9th of 602 programs submitting data for 4th Quarter 2006.
Implications for Practice: The CNS role was brought back to this hospital system for this position. The success of this role inspired the hiring of other CNS nurses, caring for patient specific populations. Unit location is not a boundary; critical care nursing now begins in the ED and eliminates “hand-off” exchange of report during a critical illness, further linking the nurse and the patient. When combined with other strategies, these process improvements enhance outcomes and survival for cardiac patients. The success of this team has been contagious and staff now suggests other areas for the application of evidence based criteria to design and improve patient care.
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