Since 2004, St. Luke’s Hospital of Cedar Rapids, Iowa, has cut its door-to-dilation mean response times for percutaneous coronary interventions (PCI) to 63 minutes, from 109 minutes.
Door-to-dilation time is the amount of time between a patient’s arrival at a catheterization lab and the successful completion of a PCI. The national
average is 104 minutes, while the Joint Commission benchmark is 90 minutes.
Shorter door-to-dilation times are associated with better survival rates and higher quality of life for patients.
Communication Matters
One of the biggest process improvements has been in staff communication around patient hand-offs between departments, such as from the ED to the catheterization lab, says Mary Ann Osborn, RN, MA, vice president and chief clinical officer.
Specifically, St. Luke’s has embraced the Institute for Healthcare Improvement’s “SBAR” technique, which advises that providers communicate by sharing the following patient information with fellow members of the team:
- Situation: What is happening?
- Background: What is the patient’s history or complaint?
- Assessment: How serious is the problem?
- Recommendation: What would resolve the issue?
“We train our teams so communication is consistent from department to department,” says Osborn.
Improved communication has also improved processes in the acute myocardial infarction (AMI) population. For instance, hospital leaders have developed a better way to alert staff when a patient presents with a possible heart attack.
“We didn’t have a defined process for bringing the care team together. Some members of the team wanted to be called, some wanted to be paged—and that could change day to day,” says Sherrie Justice, RN, MA, director of performance improvement.
Now, all on-call staff members wear pagers. When a patient with a possible AMI is admitted, the ED team sends a page with the text “MI alert” to the entire team, including pastoral care. This summons all the players to the ED so they can evaluate a possible AMI patient.
More Good Outcomes
Other promising results at St. Luke’s include the following:
- The hospital has had zero ventilator-associated pneumonia (VAP) cases for 1,000 days, compared with the national average of 4.1 VAPs per 1,000 patient days in medical ICUs.
- The severity-adjusted mortality rate for the fourth quarter 2008 was 0.67 (down from 1.10 in the second quarter of 2006), which translates to two-thirds fewer deaths than projected for the hospital’s patient population.
- The organization has had zero infections from methicillin-resistant Staphylococcus aureus since July 2008, compared with the national rate of 3.95 per every 1,000 patients.
Interviewed for this article:
Sherrie Justice, RN, MA, is director of performance improvement at St. Luke’s Hospital in Cedar Rapids, Iowa (justicsl@crstlukes.com)
Mary Ann Osborn, RN, MA, vice president and chief clinical officer at St. Luke’s (osbornma@crstlukes.com).