programme

Acute Myocardial Infarction
Team
Capital Health
January 31, 2006
Elizabeth Hodgson & Paula Holt
•
Implementation Challenges
• Mobilizing the team: busy people, full
schedules
• Resources for data collection: ICONS data,
documentation procedures and tools
•
Implementation Challenges
• Education strategy: Cardiology, Cath Lab,
Emerg, EMTs
• Engaging ED: patient flow, documentation
and time factors
Chest Pain Flow Through QEII ED
Pt arrives at ED with
C/Os of Chest Pain
Triage
Available?
NO
Pt sits outside triage
on bench until Triage
Staff available to do
assessment
Pt arrives via
ambulance with CP
Yes
Triage staff does
assessment of pt to
determine if CP may
be cardiac in nature
and CTAS given
Pt placed in WR to await Registration.
While waiting for bed ECG arranged to be
done by TS. Once ECG done it is stamped
and given to an EDP to read. If abnormal
last ECG pulled for comparison. EDP
decides if changes present. If yes pt moved
into dept. if no then pt to await further
assessment
Pt waits until Liaison Nurse/
Room is available. This may
cause a small delay in getting
ECG. Once ECG done it is
stamped and given to an EDP
to read.
No
Chest pain
Cardiac?
Liaison Nurse/
Room Available?
NO
Triage
Available
Yes
Yes
No
CN gets Hx of call
from Paramedic
and EKG. Does
assessment of pt
and decides if
appropriate for
stretcher or WR
TS call CN for Bed
availability
Bed Available?
No
Pt waits on
ambulance
stretcher until bed
available
Yes
Pt placed in
available stretcher
and Nursing staff
notified for further
assessment and
tests
Yes
Pt given Priority in EDIS
for EDP to assess pt. If
pt condition deemed
critical then EDP paged
overhead to do an
immediatie assessment
Liaison nurse does in-depth assessment
of pt.LN does ECG,Bloodwork, & CXR.
LN decides pt is Cardiac and contacts CN
for bed placement. No bed available then
LN stays with pt until a bed is available. If
condition deemed critical CN informed
and placement within dept. arranged
Pt consulted to
Cardiology
Cardiology resident makes decision on
disposition of pt. depending upon findings
EDP does assessment.
Decides if critical
intervention needed and/or
consultation to cardiology
Improvement Model
What are we trying to accomplish?
How will we know that a change is an improvement?
What changes can we make that will result in
improvement?
Act
Plan
Study
Do
AMI PDSAs
• Discharge Summary Form – new document
developed
• Smoking Cessation – “tool-kit” development to
help nurses approach patients, provide teaching
• ED times – patient flow studied, early ECG in
triage
…………………..2 examples
1.
make changes
Test again
make changes
Test discharge changes on 6.2
Test again
2.
make changes
Test timings in ER
AMI Intervention Measures
100.0%
90.0%
% of Patients Receiving Intervention
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
Baseline
Goal
Aspirin at
Discharge
Beta Blocker at
Discharge
PCI w ithin 90 min
Thrombolytic
Admin < 30 min
ACE or ARB at
Discharge
Smoking Cessation
"Perfect Care"
93.6%
90.8%
33.3%
44.4%
90.9%
22%
48.3%
90%
90%
90%
85%
85%
100%
95%
Team Approach
• Core Team
• Discharge components Team
–
–
–
–
Aspirin at discharge
ACE/ARB at discharge
Beta Blocker ate discharge
Smoking cessation
• Admission components Team
– Aspirin within 24 hours
– Door to needle 30 mins
– Door to PCI 90 mins
Remaining Challenges
• Documentation/ data collection
• Ongoing education (staff changes etc)
• Spread (DGH, Hants, Cobequid)
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