-
All Events
ACC Quality Summit 2024ACC Quality Summit 2023 -
All Content TypesAbstractAccredited ActivityAccredited CourseArticle ReviewAudio PodcastCase StudyClinical CaseCurriculumDocumente-Booke-SeriesePosterExternal LectureIndexed SlideJournal ArticleLearning QuizLive StreamMatching SlidePPT SharedSelf-Test CaseSession HighlightTechnical VideoVideo SessionWebcast
-
Sort ByRelevance
Protected by US Patents
Abstract
Co-authors: Janet Tuttle, BSN – Director- Cardiovascular Service Line, Intermountain Health- St. Mary's Regional Hospital
Janet Tuttle, BSN – Director- Cardiovascular Service Line, Intermountain Health- St. Mary's Regional Hospital Problem Statement or Scientific Question: Our primary referring hospital (facility "A") demonstrated excessive delays in door to thrombolytic administration times for STEMI patients, resulting in delayed patient care and increased risk of myocardial injury and/or death.
Background/Project Intent: This project was done in an attempt to improve patient care and outcomes. The goal was to decrease door to thrombolytic administration times through data presentation, education and support. The motivation for this project sparked from our desire to close the gap on healthcare inequities in rural areas.
Methodology: This project was unique in that there was no real working relationship with this facility. This altered our approach, as we had to start by cultivating a working, trust based relationship prior to presenting data or concerns. This is a small, 49 bed hospital, in rural Colorado with limited support and resources that is not accustomed to outside involvement. The catalyst for this project was information revealed during case adjudication, Chest Pain Steering Committee meetings and our facility KPI focus on diversity and inequity in our local healthcare setting. Our data registrar (Jamie LaVigne) brought concerns regarding our performance on NCDR Chest Pain - MI Registry™ metric #61 (Time to primary PCI among transferred patients) and #62 (Median time to primary PCI among transferred patients). This prompted a deeper data dive, and it was discovered that this facility was fairly close in proximity, but was taking extended time to transfer the patients. There was not consistent lytic administration in general, and the times it was administered were significantly past the goal of 30 minutes. The plan we created started at the very foundation of relationship building, introductions. Our team went to this facility, met with the emergency department team, their data abstractor and nurses. We brought a basket of goodies, introduced ourselves and let them know we just wanted to support them and provide any resources we could. After the initial introductions, we scheduled another visit when we saw a case come to our facility that had a door to thrombolytic administration time of under 30 minutes. We had heart cookies made for them and brought them to their group as a celebration of a job done well. During this time, our Cardiology team was creating a STEMI transfer protocol to help streamline the transfer process. We recognized that our current STEMI transfer process was convoluted and unclear, requiring a complete reworking. We also involved our internal transfer center to facilitate clear communication and a streamlined transfer process. We engaged our Cath Lab Medical Director to provide provider support and ensure the referring facilities needs were met. We then presented the reworked STEMI transfer protocol to our referring facility as a helpful tool to guide their providers. We also presented them with their data regarding door to lytic administration times. At this time the average for thrombolytic administration was 79.5 minutes. They were unaware of this, and were under the impression they were much closer to 30 minutes. They subsequently implemented the STEMI transfer protocol created by our cardiology team. Six months after implementation they had decreased their average to 66.5 minutes, with the last six months averaging 46 minutes. Current (2024) year to date average sits at 29 minutes! We recently took our COO, Ben Smalley and Heart and Vascular Medical Director, Dr. Azzouz to this facility to meet with their leadership and ED providers to celebrate this and continue to offer support. The team involved included the following: Sarah Herrera- Cardiology program Coordinator Janet Tuttle- CV Service line Director Sara Taylor- Nurse Manager Jamie LaVigne- Data Registrar Dr. S. Azzouz- Cardiologist/ Heart and Vascular Medical Director
Results: Our facility has a 250 mile radius catchment area, often with extended transfer times. In 2023 45% of our STEMI patients were transferred from outside facilities, Facility "A", has the largest percentage of all transfers, sitting at 39%. Upon initial investigation, the door to lytic administration time for faclity "A" was 79.5 minutes. After intervention as mentioned above, Q3-4 2023 they were able to reduce this to 46 minutes, resulting in an annual average of 66.5 minutes. 2024 has shown even more improvement with a year to date average of 29 minutes. As a result of this improvement, our transfer protocol had been delivered to all referring facilities in our catchment area. We will continue to monitor and focus on door to thrombolytic administration time across our region. We will partner with and support any and all facilites in need. * We have graphs and charts ready should this be selected.
Value Proposition: This project has an extensive value contribution to patients and providers, alike. Administering thrombolytics quickly reduces the risk of myocardial injury and death, resulting in better patient outcomes. Providing physicians with clean, easy to follow resources, increases their comfort with the process and allows for better effeciency in patient care. The value of the data within the NCDR Registry is unmatched as it allows for process improvement opportunities and better patient outcomes. It allows us to continue to strive for better results.
Conclusions: The intent of this project was to assist our primary referring facility in reducing door to thrombolytic administration times through a partnership focused on support and education. We were very careful to avoid overstepping and providing the support and resources they needed. Facility "A" did the hard work of implementing changes in their internal processes and deserve accolades for their incredible improvements. This will likely benefit all referring facilities in our 250 mile catchment area, as it provides resources in areas that do not have the depth of resources we do. As an area ripe with healthcare inequities, we are working hard to remove the barriers and overcome the challenges that rural healthcare and healthcare providers face.
References: Chest Pain - MI Registry™
Janet Tuttle, BSN – Director- Cardiovascular Service Line, Intermountain Health- St. Mary's Regional Hospital Problem Statement or Scientific Question: Our primary referring hospital (facility "A") demonstrated excessive delays in door to thrombolytic administration times for STEMI patients, resulting in delayed patient care and increased risk of myocardial injury and/or death.
Background/Project Intent: This project was done in an attempt to improve patient care and outcomes. The goal was to decrease door to thrombolytic administration times through data presentation, education and support. The motivation for this project sparked from our desire to close the gap on healthcare inequities in rural areas.
Methodology: This project was unique in that there was no real working relationship with this facility. This altered our approach, as we had to start by cultivating a working, trust based relationship prior to presenting data or concerns. This is a small, 49 bed hospital, in rural Colorado with limited support and resources that is not accustomed to outside involvement. The catalyst for this project was information revealed during case adjudication, Chest Pain Steering Committee meetings and our facility KPI focus on diversity and inequity in our local healthcare setting. Our data registrar (Jamie LaVigne) brought concerns regarding our performance on NCDR Chest Pain - MI Registry™ metric #61 (Time to primary PCI among transferred patients) and #62 (Median time to primary PCI among transferred patients). This prompted a deeper data dive, and it was discovered that this facility was fairly close in proximity, but was taking extended time to transfer the patients. There was not consistent lytic administration in general, and the times it was administered were significantly past the goal of 30 minutes. The plan we created started at the very foundation of relationship building, introductions. Our team went to this facility, met with the emergency department team, their data abstractor and nurses. We brought a basket of goodies, introduced ourselves and let them know we just wanted to support them and provide any resources we could. After the initial introductions, we scheduled another visit when we saw a case come to our facility that had a door to thrombolytic administration time of under 30 minutes. We had heart cookies made for them and brought them to their group as a celebration of a job done well. During this time, our Cardiology team was creating a STEMI transfer protocol to help streamline the transfer process. We recognized that our current STEMI transfer process was convoluted and unclear, requiring a complete reworking. We also involved our internal transfer center to facilitate clear communication and a streamlined transfer process. We engaged our Cath Lab Medical Director to provide provider support and ensure the referring facilities needs were met. We then presented the reworked STEMI transfer protocol to our referring facility as a helpful tool to guide their providers. We also presented them with their data regarding door to lytic administration times. At this time the average for thrombolytic administration was 79.5 minutes. They were unaware of this, and were under the impression they were much closer to 30 minutes. They subsequently implemented the STEMI transfer protocol created by our cardiology team. Six months after implementation they had decreased their average to 66.5 minutes, with the last six months averaging 46 minutes. Current (2024) year to date average sits at 29 minutes! We recently took our COO, Ben Smalley and Heart and Vascular Medical Director, Dr. Azzouz to this facility to meet with their leadership and ED providers to celebrate this and continue to offer support. The team involved included the following: Sarah Herrera- Cardiology program Coordinator Janet Tuttle- CV Service line Director Sara Taylor- Nurse Manager Jamie LaVigne- Data Registrar Dr. S. Azzouz- Cardiologist/ Heart and Vascular Medical Director
Results: Our facility has a 250 mile radius catchment area, often with extended transfer times. In 2023 45% of our STEMI patients were transferred from outside facilities, Facility "A", has the largest percentage of all transfers, sitting at 39%. Upon initial investigation, the door to lytic administration time for faclity "A" was 79.5 minutes. After intervention as mentioned above, Q3-4 2023 they were able to reduce this to 46 minutes, resulting in an annual average of 66.5 minutes. 2024 has shown even more improvement with a year to date average of 29 minutes. As a result of this improvement, our transfer protocol had been delivered to all referring facilities in our catchment area. We will continue to monitor and focus on door to thrombolytic administration time across our region. We will partner with and support any and all facilites in need. * We have graphs and charts ready should this be selected.
Value Proposition: This project has an extensive value contribution to patients and providers, alike. Administering thrombolytics quickly reduces the risk of myocardial injury and death, resulting in better patient outcomes. Providing physicians with clean, easy to follow resources, increases their comfort with the process and allows for better effeciency in patient care. The value of the data within the NCDR Registry is unmatched as it allows for process improvement opportunities and better patient outcomes. It allows us to continue to strive for better results.
Conclusions: The intent of this project was to assist our primary referring facility in reducing door to thrombolytic administration times through a partnership focused on support and education. We were very careful to avoid overstepping and providing the support and resources they needed. Facility "A" did the hard work of implementing changes in their internal processes and deserve accolades for their incredible improvements. This will likely benefit all referring facilities in our 250 mile catchment area, as it provides resources in areas that do not have the depth of resources we do. As an area ripe with healthcare inequities, we are working hard to remove the barriers and overcome the challenges that rural healthcare and healthcare providers face.
References: Chest Pain - MI Registry™
Co-authors: Janet Tuttle, BSN – Director- Cardiovascular Service Line, Intermountain Health- St. Mary's Regional Hospital
Janet Tuttle, BSN – Director- Cardiovascular Service Line, Intermountain Health- St. Mary's Regional Hospital Problem Statement or Scientific Question: Our primary referring hospital (facility "A") demonstrated excessive delays in door to thrombolytic administration times for STEMI patients, resulting in delayed patient care and increased risk of myocardial injury and/or death.
Background/Project Intent: This project was done in an attempt to improve patient care and outcomes. The goal was to decrease door to thrombolytic administration times through data presentation, education and support. The motivation for this project sparked from our desire to close the gap on healthcare inequities in rural areas.
Methodology: This project was unique in that there was no real working relationship with this facility. This altered our approach, as we had to start by cultivating a working, trust based relationship prior to presenting data or concerns. This is a small, 49 bed hospital, in rural Colorado with limited support and resources that is not accustomed to outside involvement. The catalyst for this project was information revealed during case adjudication, Chest Pain Steering Committee meetings and our facility KPI focus on diversity and inequity in our local healthcare setting. Our data registrar (Jamie LaVigne) brought concerns regarding our performance on NCDR Chest Pain - MI Registry™ metric #61 (Time to primary PCI among transferred patients) and #62 (Median time to primary PCI among transferred patients). This prompted a deeper data dive, and it was discovered that this facility was fairly close in proximity, but was taking extended time to transfer the patients. There was not consistent lytic administration in general, and the times it was administered were significantly past the goal of 30 minutes. The plan we created started at the very foundation of relationship building, introductions. Our team went to this facility, met with the emergency department team, their data abstractor and nurses. We brought a basket of goodies, introduced ourselves and let them know we just wanted to support them and provide any resources we could. After the initial introductions, we scheduled another visit when we saw a case come to our facility that had a door to thrombolytic administration time of under 30 minutes. We had heart cookies made for them and brought them to their group as a celebration of a job done well. During this time, our Cardiology team was creating a STEMI transfer protocol to help streamline the transfer process. We recognized that our current STEMI transfer process was convoluted and unclear, requiring a complete reworking. We also involved our internal transfer center to facilitate clear communication and a streamlined transfer process. We engaged our Cath Lab Medical Director to provide provider support and ensure the referring facilities needs were met. We then presented the reworked STEMI transfer protocol to our referring facility as a helpful tool to guide their providers. We also presented them with their data regarding door to lytic administration times. At this time the average for thrombolytic administration was 79.5 minutes. They were unaware of this, and were under the impression they were much closer to 30 minutes. They subsequently implemented the STEMI transfer protocol created by our cardiology team. Six months after implementation they had decreased their average to 66.5 minutes, with the last six months averaging 46 minutes. Current (2024) year to date average sits at 29 minutes! We recently took our COO, Ben Smalley and Heart and Vascular Medical Director, Dr. Azzouz to this facility to meet with their leadership and ED providers to celebrate this and continue to offer support. The team involved included the following: Sarah Herrera- Cardiology program Coordinator Janet Tuttle- CV Service line Director Sara Taylor- Nurse Manager Jamie LaVigne- Data Registrar Dr. S. Azzouz- Cardiologist/ Heart and Vascular Medical Director
Results: Our facility has a 250 mile radius catchment area, often with extended transfer times. In 2023 45% of our STEMI patients were transferred from outside facilities, Facility "A", has the largest percentage of all transfers, sitting at 39%. Upon initial investigation, the door to lytic administration time for faclity "A" was 79.5 minutes. After intervention as mentioned above, Q3-4 2023 they were able to reduce this to 46 minutes, resulting in an annual average of 66.5 minutes. 2024 has shown even more improvement with a year to date average of 29 minutes. As a result of this improvement, our transfer protocol had been delivered to all referring facilities in our catchment area. We will continue to monitor and focus on door to thrombolytic administration time across our region. We will partner with and support any and all facilites in need. * We have graphs and charts ready should this be selected.
Value Proposition: This project has an extensive value contribution to patients and providers, alike. Administering thrombolytics quickly reduces the risk of myocardial injury and death, resulting in better patient outcomes. Providing physicians with clean, easy to follow resources, increases their comfort with the process and allows for better effeciency in patient care. The value of the data within the NCDR Registry is unmatched as it allows for process improvement opportunities and better patient outcomes. It allows us to continue to strive for better results.
Conclusions: The intent of this project was to assist our primary referring facility in reducing door to thrombolytic administration times through a partnership focused on support and education. We were very careful to avoid overstepping and providing the support and resources they needed. Facility "A" did the hard work of implementing changes in their internal processes and deserve accolades for their incredible improvements. This will likely benefit all referring facilities in our 250 mile catchment area, as it provides resources in areas that do not have the depth of resources we do. As an area ripe with healthcare inequities, we are working hard to remove the barriers and overcome the challenges that rural healthcare and healthcare providers face.
References: Chest Pain - MI Registry™
Janet Tuttle, BSN – Director- Cardiovascular Service Line, Intermountain Health- St. Mary's Regional Hospital Problem Statement or Scientific Question: Our primary referring hospital (facility "A") demonstrated excessive delays in door to thrombolytic administration times for STEMI patients, resulting in delayed patient care and increased risk of myocardial injury and/or death.
Background/Project Intent: This project was done in an attempt to improve patient care and outcomes. The goal was to decrease door to thrombolytic administration times through data presentation, education and support. The motivation for this project sparked from our desire to close the gap on healthcare inequities in rural areas.
Methodology: This project was unique in that there was no real working relationship with this facility. This altered our approach, as we had to start by cultivating a working, trust based relationship prior to presenting data or concerns. This is a small, 49 bed hospital, in rural Colorado with limited support and resources that is not accustomed to outside involvement. The catalyst for this project was information revealed during case adjudication, Chest Pain Steering Committee meetings and our facility KPI focus on diversity and inequity in our local healthcare setting. Our data registrar (Jamie LaVigne) brought concerns regarding our performance on NCDR Chest Pain - MI Registry™ metric #61 (Time to primary PCI among transferred patients) and #62 (Median time to primary PCI among transferred patients). This prompted a deeper data dive, and it was discovered that this facility was fairly close in proximity, but was taking extended time to transfer the patients. There was not consistent lytic administration in general, and the times it was administered were significantly past the goal of 30 minutes. The plan we created started at the very foundation of relationship building, introductions. Our team went to this facility, met with the emergency department team, their data abstractor and nurses. We brought a basket of goodies, introduced ourselves and let them know we just wanted to support them and provide any resources we could. After the initial introductions, we scheduled another visit when we saw a case come to our facility that had a door to thrombolytic administration time of under 30 minutes. We had heart cookies made for them and brought them to their group as a celebration of a job done well. During this time, our Cardiology team was creating a STEMI transfer protocol to help streamline the transfer process. We recognized that our current STEMI transfer process was convoluted and unclear, requiring a complete reworking. We also involved our internal transfer center to facilitate clear communication and a streamlined transfer process. We engaged our Cath Lab Medical Director to provide provider support and ensure the referring facilities needs were met. We then presented the reworked STEMI transfer protocol to our referring facility as a helpful tool to guide their providers. We also presented them with their data regarding door to lytic administration times. At this time the average for thrombolytic administration was 79.5 minutes. They were unaware of this, and were under the impression they were much closer to 30 minutes. They subsequently implemented the STEMI transfer protocol created by our cardiology team. Six months after implementation they had decreased their average to 66.5 minutes, with the last six months averaging 46 minutes. Current (2024) year to date average sits at 29 minutes! We recently took our COO, Ben Smalley and Heart and Vascular Medical Director, Dr. Azzouz to this facility to meet with their leadership and ED providers to celebrate this and continue to offer support. The team involved included the following: Sarah Herrera- Cardiology program Coordinator Janet Tuttle- CV Service line Director Sara Taylor- Nurse Manager Jamie LaVigne- Data Registrar Dr. S. Azzouz- Cardiologist/ Heart and Vascular Medical Director
Results: Our facility has a 250 mile radius catchment area, often with extended transfer times. In 2023 45% of our STEMI patients were transferred from outside facilities, Facility "A", has the largest percentage of all transfers, sitting at 39%. Upon initial investigation, the door to lytic administration time for faclity "A" was 79.5 minutes. After intervention as mentioned above, Q3-4 2023 they were able to reduce this to 46 minutes, resulting in an annual average of 66.5 minutes. 2024 has shown even more improvement with a year to date average of 29 minutes. As a result of this improvement, our transfer protocol had been delivered to all referring facilities in our catchment area. We will continue to monitor and focus on door to thrombolytic administration time across our region. We will partner with and support any and all facilites in need. * We have graphs and charts ready should this be selected.
Value Proposition: This project has an extensive value contribution to patients and providers, alike. Administering thrombolytics quickly reduces the risk of myocardial injury and death, resulting in better patient outcomes. Providing physicians with clean, easy to follow resources, increases their comfort with the process and allows for better effeciency in patient care. The value of the data within the NCDR Registry is unmatched as it allows for process improvement opportunities and better patient outcomes. It allows us to continue to strive for better results.
Conclusions: The intent of this project was to assist our primary referring facility in reducing door to thrombolytic administration times through a partnership focused on support and education. We were very careful to avoid overstepping and providing the support and resources they needed. Facility "A" did the hard work of implementing changes in their internal processes and deserve accolades for their incredible improvements. This will likely benefit all referring facilities in our 250 mile catchment area, as it provides resources in areas that do not have the depth of resources we do. As an area ripe with healthcare inequities, we are working hard to remove the barriers and overcome the challenges that rural healthcare and healthcare providers face.
References: Chest Pain - MI Registry™
Rural Outreach- Door to Thrombolytics
Mrs. Sarah Herrera CCRP
Affiliations:
null
null
Abstract
Co-authors: Janet Tuttle, BSN – Director- Cardiovascular Service Line, Intermountain Health- St. Mary's Regional Hospital
Janet Tuttle, BSN – Director- Cardiovascular Service Line, Intermountain Health- St. Mary's Regional Hospital Problem Statement or Scientific Question: Our primary referring hospital (facility "A") demonstrated excessive delays in door to thrombolytic administration times for STEMI patients, resulting in delayed patient care and increased risk of myocardial injury and/or death.
Background/Project Intent: This project was done in an attempt to improve patient care and outcomes. The goal was to decrease door to thrombolytic administration times through data presentation, education and support. The motivation for this project sparked from our desire to close the gap on healthcare inequities in rural areas.
Methodology: This project was unique in that there was no real working relationship with this facility. This altered our approach, as we had to start by cultivating a working, trust based relationship prior to presenting data or concerns. This is a small, 49 bed hospital, in rural Colorado with limited support and resources that is not accustomed to outside involvement. The catalyst for this project was information revealed during case adjudication, Chest Pain Steering Committee meetings and our facility KPI focus on diversity and inequity in our local healthcare setting. Our data registrar (Jamie LaVigne) brought concerns regarding our performance on NCDR Chest Pain - MI Registry™ metric #61 (Time to primary PCI among transferred patients) and #62 (Median time to primary PCI among transferred patients). This prompted a deeper data dive, and it was discovered that this facility was fairly close in proximity, but was taking extended time to transfer the patients. There was not consistent lytic administration in general, and the times it was administered were significantly past the goal of 30 minutes. The plan we created started at the very foundation of relationship building, introductions. Our team went to this facility, met with the emergency department team, their data abstractor and nurses. We brought a basket of goodies, introduced ourselves and let them know we just wanted to support them and provide any resources we could. After the initial introductions, we scheduled another visit when we saw a case come to our facility that had a door to thrombolytic administration time of under 30 minutes. We had heart cookies made for them and brought them to their group as a celebration of a job done well. During this time, our Cardiology team was creating a STEMI transfer protocol to help streamline the transfer process. We recognized that our current STEMI transfer process was convoluted and unclear, requiring a complete reworking. We also involved our internal transfer center to facilitate clear communication and a streamlined transfer process. We engaged our Cath Lab Medical Director to provide provider support and ensure the referring facilities needs were met. We then presented the reworked STEMI transfer protocol to our referring facility as a helpful tool to guide their providers. We also presented them with their data regarding door to lytic administration times. At this time the average for thrombolytic administration was 79.5 minutes. They were unaware of this, and were under the impression they were much closer to 30 minutes. They subsequently implemented the STEMI transfer protocol created by our cardiology team. Six months after implementation they had decreased their average to 66.5 minutes, with the last six months averaging 46 minutes. Current (2024) year to date average sits at 29 minutes! We recently took our COO, Ben Smalley and Heart and Vascular Medical Director, Dr. Azzouz to this facility to meet with their leadership and ED providers to celebrate this and continue to offer support. The team involved included the following: Sarah Herrera- Cardiology program Coordinator Janet Tuttle- CV Service line Director Sara Taylor- Nurse Manager Jamie LaVigne- Data Registrar Dr. S. Azzouz- Cardiologist/ Heart and Vascular Medical Director
Results: Our facility has a 250 mile radius catchment area, often with extended transfer times. In 2023 45% of our STEMI patients were transferred from outside facilities, Facility "A", has the largest percentage of all transfers, sitting at 39%. Upon initial investigation, the door to lytic administration time for faclity "A" was 79.5 minutes. After intervention as mentioned above, Q3-4 2023 they were able to reduce this to 46 minutes, resulting in an annual average of 66.5 minutes. 2024 has shown even more improvement with a year to date average of 29 minutes. As a result of this improvement, our transfer protocol had been delivered to all referring facilities in our catchment area. We will continue to monitor and focus on door to thrombolytic administration time across our region. We will partner with and support any and all facilites in need. * We have graphs and charts ready should this be selected.
Value Proposition: This project has an extensive value contribution to patients and providers, alike. Administering thrombolytics quickly reduces the risk of myocardial injury and death, resulting in better patient outcomes. Providing physicians with clean, easy to follow resources, increases their comfort with the process and allows for better effeciency in patient care. The value of the data within the NCDR Registry is unmatched as it allows for process improvement opportunities and better patient outcomes. It allows us to continue to strive for better results.
Conclusions: The intent of this project was to assist our primary referring facility in reducing door to thrombolytic administration times through a partnership focused on support and education. We were very careful to avoid overstepping and providing the support and resources they needed. Facility "A" did the hard work of implementing changes in their internal processes and deserve accolades for their incredible improvements. This will likely benefit all referring facilities in our 250 mile catchment area, as it provides resources in areas that do not have the depth of resources we do. As an area ripe with healthcare inequities, we are working hard to remove the barriers and overcome the challenges that rural healthcare and healthcare providers face.
References: Chest Pain - MI Registry™
Janet Tuttle, BSN – Director- Cardiovascular Service Line, Intermountain Health- St. Mary's Regional Hospital Problem Statement or Scientific Question: Our primary referring hospital (facility "A") demonstrated excessive delays in door to thrombolytic administration times for STEMI patients, resulting in delayed patient care and increased risk of myocardial injury and/or death.
Background/Project Intent: This project was done in an attempt to improve patient care and outcomes. The goal was to decrease door to thrombolytic administration times through data presentation, education and support. The motivation for this project sparked from our desire to close the gap on healthcare inequities in rural areas.
Methodology: This project was unique in that there was no real working relationship with this facility. This altered our approach, as we had to start by cultivating a working, trust based relationship prior to presenting data or concerns. This is a small, 49 bed hospital, in rural Colorado with limited support and resources that is not accustomed to outside involvement. The catalyst for this project was information revealed during case adjudication, Chest Pain Steering Committee meetings and our facility KPI focus on diversity and inequity in our local healthcare setting. Our data registrar (Jamie LaVigne) brought concerns regarding our performance on NCDR Chest Pain - MI Registry™ metric #61 (Time to primary PCI among transferred patients) and #62 (Median time to primary PCI among transferred patients). This prompted a deeper data dive, and it was discovered that this facility was fairly close in proximity, but was taking extended time to transfer the patients. There was not consistent lytic administration in general, and the times it was administered were significantly past the goal of 30 minutes. The plan we created started at the very foundation of relationship building, introductions. Our team went to this facility, met with the emergency department team, their data abstractor and nurses. We brought a basket of goodies, introduced ourselves and let them know we just wanted to support them and provide any resources we could. After the initial introductions, we scheduled another visit when we saw a case come to our facility that had a door to thrombolytic administration time of under 30 minutes. We had heart cookies made for them and brought them to their group as a celebration of a job done well. During this time, our Cardiology team was creating a STEMI transfer protocol to help streamline the transfer process. We recognized that our current STEMI transfer process was convoluted and unclear, requiring a complete reworking. We also involved our internal transfer center to facilitate clear communication and a streamlined transfer process. We engaged our Cath Lab Medical Director to provide provider support and ensure the referring facilities needs were met. We then presented the reworked STEMI transfer protocol to our referring facility as a helpful tool to guide their providers. We also presented them with their data regarding door to lytic administration times. At this time the average for thrombolytic administration was 79.5 minutes. They were unaware of this, and were under the impression they were much closer to 30 minutes. They subsequently implemented the STEMI transfer protocol created by our cardiology team. Six months after implementation they had decreased their average to 66.5 minutes, with the last six months averaging 46 minutes. Current (2024) year to date average sits at 29 minutes! We recently took our COO, Ben Smalley and Heart and Vascular Medical Director, Dr. Azzouz to this facility to meet with their leadership and ED providers to celebrate this and continue to offer support. The team involved included the following: Sarah Herrera- Cardiology program Coordinator Janet Tuttle- CV Service line Director Sara Taylor- Nurse Manager Jamie LaVigne- Data Registrar Dr. S. Azzouz- Cardiologist/ Heart and Vascular Medical Director
Results: Our facility has a 250 mile radius catchment area, often with extended transfer times. In 2023 45% of our STEMI patients were transferred from outside facilities, Facility "A", has the largest percentage of all transfers, sitting at 39%. Upon initial investigation, the door to lytic administration time for faclity "A" was 79.5 minutes. After intervention as mentioned above, Q3-4 2023 they were able to reduce this to 46 minutes, resulting in an annual average of 66.5 minutes. 2024 has shown even more improvement with a year to date average of 29 minutes. As a result of this improvement, our transfer protocol had been delivered to all referring facilities in our catchment area. We will continue to monitor and focus on door to thrombolytic administration time across our region. We will partner with and support any and all facilites in need. * We have graphs and charts ready should this be selected.
Value Proposition: This project has an extensive value contribution to patients and providers, alike. Administering thrombolytics quickly reduces the risk of myocardial injury and death, resulting in better patient outcomes. Providing physicians with clean, easy to follow resources, increases their comfort with the process and allows for better effeciency in patient care. The value of the data within the NCDR Registry is unmatched as it allows for process improvement opportunities and better patient outcomes. It allows us to continue to strive for better results.
Conclusions: The intent of this project was to assist our primary referring facility in reducing door to thrombolytic administration times through a partnership focused on support and education. We were very careful to avoid overstepping and providing the support and resources they needed. Facility "A" did the hard work of implementing changes in their internal processes and deserve accolades for their incredible improvements. This will likely benefit all referring facilities in our 250 mile catchment area, as it provides resources in areas that do not have the depth of resources we do. As an area ripe with healthcare inequities, we are working hard to remove the barriers and overcome the challenges that rural healthcare and healthcare providers face.
References: Chest Pain - MI Registry™
Co-authors: Janet Tuttle, BSN – Director- Cardiovascular Service Line, Intermountain Health- St. Mary's Regional Hospital
Janet Tuttle, BSN – Director- Cardiovascular Service Line, Intermountain Health- St. Mary's Regional Hospital Problem Statement or Scientific Question: Our primary referring hospital (facility "A") demonstrated excessive delays in door to thrombolytic administration times for STEMI patients, resulting in delayed patient care and increased risk of myocardial injury and/or death.
Background/Project Intent: This project was done in an attempt to improve patient care and outcomes. The goal was to decrease door to thrombolytic administration times through data presentation, education and support. The motivation for this project sparked from our desire to close the gap on healthcare inequities in rural areas.
Methodology: This project was unique in that there was no real working relationship with this facility. This altered our approach, as we had to start by cultivating a working, trust based relationship prior to presenting data or concerns. This is a small, 49 bed hospital, in rural Colorado with limited support and resources that is not accustomed to outside involvement. The catalyst for this project was information revealed during case adjudication, Chest Pain Steering Committee meetings and our facility KPI focus on diversity and inequity in our local healthcare setting. Our data registrar (Jamie LaVigne) brought concerns regarding our performance on NCDR Chest Pain - MI Registry™ metric #61 (Time to primary PCI among transferred patients) and #62 (Median time to primary PCI among transferred patients). This prompted a deeper data dive, and it was discovered that this facility was fairly close in proximity, but was taking extended time to transfer the patients. There was not consistent lytic administration in general, and the times it was administered were significantly past the goal of 30 minutes. The plan we created started at the very foundation of relationship building, introductions. Our team went to this facility, met with the emergency department team, their data abstractor and nurses. We brought a basket of goodies, introduced ourselves and let them know we just wanted to support them and provide any resources we could. After the initial introductions, we scheduled another visit when we saw a case come to our facility that had a door to thrombolytic administration time of under 30 minutes. We had heart cookies made for them and brought them to their group as a celebration of a job done well. During this time, our Cardiology team was creating a STEMI transfer protocol to help streamline the transfer process. We recognized that our current STEMI transfer process was convoluted and unclear, requiring a complete reworking. We also involved our internal transfer center to facilitate clear communication and a streamlined transfer process. We engaged our Cath Lab Medical Director to provide provider support and ensure the referring facilities needs were met. We then presented the reworked STEMI transfer protocol to our referring facility as a helpful tool to guide their providers. We also presented them with their data regarding door to lytic administration times. At this time the average for thrombolytic administration was 79.5 minutes. They were unaware of this, and were under the impression they were much closer to 30 minutes. They subsequently implemented the STEMI transfer protocol created by our cardiology team. Six months after implementation they had decreased their average to 66.5 minutes, with the last six months averaging 46 minutes. Current (2024) year to date average sits at 29 minutes! We recently took our COO, Ben Smalley and Heart and Vascular Medical Director, Dr. Azzouz to this facility to meet with their leadership and ED providers to celebrate this and continue to offer support. The team involved included the following: Sarah Herrera- Cardiology program Coordinator Janet Tuttle- CV Service line Director Sara Taylor- Nurse Manager Jamie LaVigne- Data Registrar Dr. S. Azzouz- Cardiologist/ Heart and Vascular Medical Director
Results: Our facility has a 250 mile radius catchment area, often with extended transfer times. In 2023 45% of our STEMI patients were transferred from outside facilities, Facility "A", has the largest percentage of all transfers, sitting at 39%. Upon initial investigation, the door to lytic administration time for faclity "A" was 79.5 minutes. After intervention as mentioned above, Q3-4 2023 they were able to reduce this to 46 minutes, resulting in an annual average of 66.5 minutes. 2024 has shown even more improvement with a year to date average of 29 minutes. As a result of this improvement, our transfer protocol had been delivered to all referring facilities in our catchment area. We will continue to monitor and focus on door to thrombolytic administration time across our region. We will partner with and support any and all facilites in need. * We have graphs and charts ready should this be selected.
Value Proposition: This project has an extensive value contribution to patients and providers, alike. Administering thrombolytics quickly reduces the risk of myocardial injury and death, resulting in better patient outcomes. Providing physicians with clean, easy to follow resources, increases their comfort with the process and allows for better effeciency in patient care. The value of the data within the NCDR Registry is unmatched as it allows for process improvement opportunities and better patient outcomes. It allows us to continue to strive for better results.
Conclusions: The intent of this project was to assist our primary referring facility in reducing door to thrombolytic administration times through a partnership focused on support and education. We were very careful to avoid overstepping and providing the support and resources they needed. Facility "A" did the hard work of implementing changes in their internal processes and deserve accolades for their incredible improvements. This will likely benefit all referring facilities in our 250 mile catchment area, as it provides resources in areas that do not have the depth of resources we do. As an area ripe with healthcare inequities, we are working hard to remove the barriers and overcome the challenges that rural healthcare and healthcare providers face.
References: Chest Pain - MI Registry™
Janet Tuttle, BSN – Director- Cardiovascular Service Line, Intermountain Health- St. Mary's Regional Hospital Problem Statement or Scientific Question: Our primary referring hospital (facility "A") demonstrated excessive delays in door to thrombolytic administration times for STEMI patients, resulting in delayed patient care and increased risk of myocardial injury and/or death.
Background/Project Intent: This project was done in an attempt to improve patient care and outcomes. The goal was to decrease door to thrombolytic administration times through data presentation, education and support. The motivation for this project sparked from our desire to close the gap on healthcare inequities in rural areas.
Methodology: This project was unique in that there was no real working relationship with this facility. This altered our approach, as we had to start by cultivating a working, trust based relationship prior to presenting data or concerns. This is a small, 49 bed hospital, in rural Colorado with limited support and resources that is not accustomed to outside involvement. The catalyst for this project was information revealed during case adjudication, Chest Pain Steering Committee meetings and our facility KPI focus on diversity and inequity in our local healthcare setting. Our data registrar (Jamie LaVigne) brought concerns regarding our performance on NCDR Chest Pain - MI Registry™ metric #61 (Time to primary PCI among transferred patients) and #62 (Median time to primary PCI among transferred patients). This prompted a deeper data dive, and it was discovered that this facility was fairly close in proximity, but was taking extended time to transfer the patients. There was not consistent lytic administration in general, and the times it was administered were significantly past the goal of 30 minutes. The plan we created started at the very foundation of relationship building, introductions. Our team went to this facility, met with the emergency department team, their data abstractor and nurses. We brought a basket of goodies, introduced ourselves and let them know we just wanted to support them and provide any resources we could. After the initial introductions, we scheduled another visit when we saw a case come to our facility that had a door to thrombolytic administration time of under 30 minutes. We had heart cookies made for them and brought them to their group as a celebration of a job done well. During this time, our Cardiology team was creating a STEMI transfer protocol to help streamline the transfer process. We recognized that our current STEMI transfer process was convoluted and unclear, requiring a complete reworking. We also involved our internal transfer center to facilitate clear communication and a streamlined transfer process. We engaged our Cath Lab Medical Director to provide provider support and ensure the referring facilities needs were met. We then presented the reworked STEMI transfer protocol to our referring facility as a helpful tool to guide their providers. We also presented them with their data regarding door to lytic administration times. At this time the average for thrombolytic administration was 79.5 minutes. They were unaware of this, and were under the impression they were much closer to 30 minutes. They subsequently implemented the STEMI transfer protocol created by our cardiology team. Six months after implementation they had decreased their average to 66.5 minutes, with the last six months averaging 46 minutes. Current (2024) year to date average sits at 29 minutes! We recently took our COO, Ben Smalley and Heart and Vascular Medical Director, Dr. Azzouz to this facility to meet with their leadership and ED providers to celebrate this and continue to offer support. The team involved included the following: Sarah Herrera- Cardiology program Coordinator Janet Tuttle- CV Service line Director Sara Taylor- Nurse Manager Jamie LaVigne- Data Registrar Dr. S. Azzouz- Cardiologist/ Heart and Vascular Medical Director
Results: Our facility has a 250 mile radius catchment area, often with extended transfer times. In 2023 45% of our STEMI patients were transferred from outside facilities, Facility "A", has the largest percentage of all transfers, sitting at 39%. Upon initial investigation, the door to lytic administration time for faclity "A" was 79.5 minutes. After intervention as mentioned above, Q3-4 2023 they were able to reduce this to 46 minutes, resulting in an annual average of 66.5 minutes. 2024 has shown even more improvement with a year to date average of 29 minutes. As a result of this improvement, our transfer protocol had been delivered to all referring facilities in our catchment area. We will continue to monitor and focus on door to thrombolytic administration time across our region. We will partner with and support any and all facilites in need. * We have graphs and charts ready should this be selected.
Value Proposition: This project has an extensive value contribution to patients and providers, alike. Administering thrombolytics quickly reduces the risk of myocardial injury and death, resulting in better patient outcomes. Providing physicians with clean, easy to follow resources, increases their comfort with the process and allows for better effeciency in patient care. The value of the data within the NCDR Registry is unmatched as it allows for process improvement opportunities and better patient outcomes. It allows us to continue to strive for better results.
Conclusions: The intent of this project was to assist our primary referring facility in reducing door to thrombolytic administration times through a partnership focused on support and education. We were very careful to avoid overstepping and providing the support and resources they needed. Facility "A" did the hard work of implementing changes in their internal processes and deserve accolades for their incredible improvements. This will likely benefit all referring facilities in our 250 mile catchment area, as it provides resources in areas that do not have the depth of resources we do. As an area ripe with healthcare inequities, we are working hard to remove the barriers and overcome the challenges that rural healthcare and healthcare providers face.
References: Chest Pain - MI Registry™
{{ help_message }}
{{filter}}