Improving Efficiencies in STEMI Care via the DMAIC Framework: Report of a Successful Quality Improvement Project
John Porter1, Erin M Larson, Courtney E Bennett
1Author Affiliations: Cardiac Catheterization Laboratory (Drs Porter, Konz and Eastman), Department of Nursing (Drs Larson and Rentz), Cardiac Intensive Care Unit (Dr Bennett), Mayo Clinic Ambulance Service (Drs Liedl, Churchill, Berns, and Juntunen); Division of Clinical Trials and Biostatistics (Dr Johnson); and Department of Emergency Medicine (Dr Laudon), Mayo Clinic, Rochester, Minnesota.
Background:
Timely recognition, diagnosis, and treatment of ST-segment elevation myocardial infarctions (STEMIs) are critical for patient survival.
Local Problem:
Our door-to-balloon (D2B) times, a key quality metric, were increasing.
Methods:
The DMAIC (Define, Measure, Analyze, Improve, Control) framework was used for this quality improvement project to determine gaps in care and to improve efficiency.
Interventions:
We streamlined STEMI patient care models, eliminating unnecessary steps, codifying throughput pathways, and improving interdepartmental communication.
Results:
Median D2B times decreased from 62.5 to 57 minutes in patients initially seen at the acute care facility and from 116 to 114 minutes in patients who transferred to our facility. We observed no increase in the number of patients arriving at the cardiac catheterization laboratory before the room or team were ready.
Conclusions:
A nurse-led quality improvement project that includes nurses directly involved in the care of patients can achieve real improvements in quality of care.
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