Emergency Medicine Fri 17 July 2020 Reducing door to reperfusion time in st elevation myocardial infarction patients: quality improvement study in the department of emergency medicine aiims new delhi
Researcher : Bharath
Research Guide : Aggarwal praveen
Institution Name : Aiims new delhi


Background: Our Emergency Department (ED) caters to 450+ patients every day. The focus of our study were patients diagnosed with ST elevation myocardial infarction (STEMI) in ED. Patients diagnosed with STEMI were not receiving Percutaneous Coronary Intervention (PCI) within 90 minutes from arrival as recommended by the American Heart Association Guidelines. Aim: Increasing the percentage of STEMI patients undergoing primary percutaneous coronary intervention (PCI) with Door to Balloon time of < 90 minutes by 30%. Methods and Interventions: The Quality Improvement(QI) team including doctors, nurses, health assistants and security guards was formed. A baseline process study of patient’s journey was done. The causes of delays were discussed using process flowchart and fish bone analytical tools. Some change ideas tested are mentioned as follows: 1) Focussed group discussions was done to create awareness regarding the care of STEMI patients, discuss common inefficiencies in the system and to motivate staff to join the change movement. The mean door to ECG time during 9th April to 23rd April 2018 reduced from baseline 20 minutes to 13 minutes. 2)Fast track lane from triage to treatment area: The idea was tested in the morning shift and there was significant reduction in average time to transfer from 10 to 6 mins. After implementation, average door to ECG time reduced to 13 minutes between 8th and 22nd of June 2018. 3) Induction program: An educational program to residents was organised on 7th & 13th of July 2018. The program included aspects of emergency care and training on STEMI and approach to patients with chest pain. The data collected between 8th & 22nd July 2018 showed improvement in door to ECG time to 13 minutes and door to cardiology communication time to 19 minutes. The induction program became an integral part of the department activity thereafter. 4) Early interpretation of ECG by Emergency Medicine Senior Resident (SR): Early involvement of Emergency medicine SR in interpretation of ECG and diagnosis led to significant reduction in communication time with the cardiology team by the end of January 2019. At the end of intervention phase, the percentage of patients undergoing PCI within 90 minutes was 70% as compared to baseline of 22.22% at the start of the project. Results: After 4.5 months of post intervention 70% percentage patients underwent PCI within 90 minutes. Conclusion: As much as science, QI is a cultural change. Engaging with frontline staff, taking their inputs and working with all cadres of staff as a team was the single most important change concept. To bring about sustainable improvement, the QI team needs to address both individual and system barriers. There is a significant improvement in the percentage of STEMI patients receiving PCI within 90 minutes of arrival. This has led to improvement in emergency cardiac services at our centre and the community in South New Delhi.

DOI: 1594993978   Year of publication: 2020

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