Kelly L Cross RN State University of New York Institute of Technology In patients who present to the emergency department with chief complaint of chest pain Do EKGs completed and interpreted within 10 minutes improve the throughput in the emergency ID: 278053
Download Presentation The PPT/PDF document "Code EKG: Expediting Chest Pain Care in..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Code EKG: Expediting Chest Pain Care in Triage Kelly L. Cross, RN State University of New York Institute of Technology
In
patients who present to the emergency department with chief complaint of chest pain: Do EKG’s completed and interpreted within 10 minutes improve the throughput in the emergency department; compared to those with chest pain who did not meet the 10 minute criteria ?
Chest pain is a common urgent condition that is treated in the Emergency Department (ED). The primary purpose of our study was to determine if we could improve adherence to door-to-ECG time goal of 10 minutes or less for patients who presented to our ED with chest pain by implementing a new process for obtaining ECGs. The secondary goal was to describe how the new process affected the door-to-balloon (D2B) time for STEMI patient. Lastly, we hoped it would decrease our ED LOS overall. PLANDOCHECKACT and other QI tools help to validate the process changes. Kurt Lewin’s 3 stage change theory including unfreeze-change-refreeze is utilized in this process.
Introduction
Methods
Results
Acknowledgements
Retrospective random sampling of 50 chest pain patients/month and ALL STEMI patients per month. Specific time snapshots captured and report generated . Time specific points verified in medical record. Data compiled and analyzed for trends. Reported out to ED, EMS, Quality, and Steering Committee, Service Line and CNO at monthly committee meetings.
Code EKG Implementation
Thank You Christina for mentoring and providing immeasurable insight
Conclusion
Accreditation Steering Committee established
Criteria outlined Process change implemented implementation of new Code EKG process. Reg EKG within 5 minutes. EKG MD interpretation within 5 minutes = D2 EKG </= 10 minutes. D2B= < 90 minutes
..PICO Statement
The Emergency Department data , to date, does not demonstrate a specific benefit for improved LOS in the ED, for all patients with chest pain and EKG completed within 10 minutes; however, there is significant evidence to validate early EKG interpretation and its documented benefit to improved morbidity and mortality rates in confirmed STEMI patients. Facility Door-To-Balloon time as reported to ACC - 52 minutes !!
** References Available in Handout
Metrics
Longer ED LOS, is not simply a volume problem but also, a systems problem. Lack of streamlined processes.
Door -To-Balloon times < 90 minutes per American College of CardiologyThe majority of patients with ischemic symptoms did not receive an ECG within 10 minutes of hospital presentation as recommended in evidence-based guidelinesThe American College of Cardiology/American Heart Association (ACC/AHA) guidelines specify that an ECG should be obtained and interpreted within 10 minutes of arrival to the emergency department in patients with symptoms suspicious of ACS
The Evidence