2022 Quality Summit ePosters (Non-CE) - CathPCI Registry-1. Reducing Door to ECG a Key Component to Reducing Door to Balloon Time

1. Reducing Door to ECG a Key Component to Reducing Door to Balloon Time

Pdf Summary

The Ohio State Wexner Medical Center in Columbus, Ohio conducted a process improvement project to reduce the door to electrocardiogram (ECG) time in their emergency department (ED) for patients with chest discomfort or symptoms suggestive of a ST elevation myocardial infarction (STEMI). The goal was to improve the time it takes to obtain and show the ECG to a physician within 10 minutes.<br /><br />The team used the Plan, Do, Check, Act (PDCA) methodology for their project. They conducted a retrospective review of patients with long door to ECG times and identified areas for improvement. They found that the lack of bar scanning capability in their ECG machines led to longer acquisition times, and it took an average of 7 minutes to locate a physician to sign the ECG. The ED was also experiencing a high volume of ECGs, with an average of 2400 in a 24-hour period, and it took an average of 9.5 hours for physicians to review all the ECGs.<br /><br />To address these challenges, the team implemented bar scanning technology for patient identification and introduced rapid electronic delivery of ECGs to physicians via iPhones or iPads. They also implemented a process to distribute the workload evenly among physicians. These changes resulted in significant improvements. The door to ECG time of 10 minutes or less increased from 63% to 100%, and the median time for physician review and signing of "STEMI" ECGs was 4.27 minutes. Additionally, the hospital consistently met the quality metrics for door to balloon time for STEMI patients.<br /><br />The project had several positive outcomes, including reduced wait times for patients, fewer entry errors for ECGs, faster door to balloon time, lower mortality, and a reduced workload for nursing staff. The team also faced the challenge of implementing these changes during the COVID-19 pandemic.<br /><br />In conclusion, the Ohio State Wexner Medical Center successfully improved their process for obtaining and showing ECGs to physicians within the recommended 10-minute benchmark time. This resulted in faster diagnosis and treatment for patients with potential STEMI, and ultimately improved patient outcomes.

Keywords

Ohio State Wexner Medical Center

Columbus

process improvement

door to electrocardiogram time

emergency department

ST elevation myocardial infarction

bar scanning capability

physician review

rapid electronic delivery

workload distribution