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Achieving door-to-balloon times in less than 90 minutes. Development of a flow chart
Saul Benitez1, Marilyn Pattillo
1Seton Heart Specialty Care and Transplant Center, 1700 Red River, Austin, TX 78701, USA.
Insights
Improving door-to-balloon times for ST-segment elevation myocardial infarction (STEMI) patients is crucial. An advanced practice nurse identified barriers like serum creatinine checks and cardiologist-ED physician collaboration, highlighting the need for interdisciplinary teams and education.
Area of Science:
- Cardiology
- Healthcare Management
- Nursing Practice
Background:
- Percutaneous coronary intervention (PCI) within 90 minutes significantly reduces mortality and morbidity in ST-segment elevation myocardial infarction (STEMI) patients.
- The American College of Cardiology's 2006 initiative aimed to standardize rapid PCI protocols nationwide.
Purpose of the Study:
- To describe an advanced practice nurse's efforts to improve STEMI care systems.
- To identify and analyze implementation challenges in achieving optimal door-to-balloon times.
Main Methods:
- Development and piloting of a flowchart to streamline STEMI patient transfer from the emergency department (ED) to the cardiac catheterization laboratory.
- Identification and qualitative analysis of implementation barriers.
Main Results:
- Key barriers included delays due to serum creatinine level checks before PCI, potentially causing kidney injury from contrast dye, and reluctance from some cardiologists to empower ED physicians to initiate the cardiac catheterization laboratory.
- The need for an interdisciplinary team approach was highlighted as a solution for some barriers.
Conclusions:
- System changes are necessary to optimize STEMI care pathways.
- Addressing barriers requires a multifaceted approach, including interdisciplinary collaboration, continued education, and revised protocols to balance speed with patient safety (e.g., renal function assessment).
Abstract:
The use of percutaneous coronary intervention (PCI) for patients presenting with an ST-segment elevation myocardial infarction (STEMI) in less than 90 minutes has shown to significantly reduce mortality and morbidity. In 2006, the American College of Cardiology launched a national door-to-balloon initiative to "take the extraordinary performance of a few hospitals and make it the ordinary performance of every hospital." The purpose of this article is to present an advanced practice nurse's attempt to change practice and the challenges faced when attempted to improve upon a system. A flow chart was created and piloted to illustrate the appropriate steps needed to take to get a patient with a STEMI who walks into the emergency department (ED) to the cardiac catheterization laboratory. Implementation barriers were identified: (1) "going too fast"--not waiting for findings of serum creatinine levels and sending patients into kidney failure secondary to the contrast dye that is used during PCI; and (2) hesitation by certain cardiologists to allow ED physicians to initiate the cardiac catheterization laboratory. Although evidence is clear that change is necessary and that some of the barriers have easy solutions (eg, the use of an interdisciplinary team), some barriers are harder to tackle and need continued education.
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