Since reducing the cardiac morbidity and mortality rates is recognized as the task of paramount importance, proper STEMI patient care becomes the cornerstone of hospitals’ activities (Lawson et al., 2014). Kendall Regional Medical Center (KRMC) is not an exception: following the recommendations provided by the American Heart Association (AHA), it seeks for better solutions aimed at improving patient health.
In this context, the reduction of door-to-balloon (D2B) time is one of the most significant issues. The purpose of this paper is to summarize the key points related to the evidence-based strategies which are adopted at the medical center and reflect on the current situation. The results of the observations made during the work at the ER and CVL departments for six months in both cases and interaction with the stakeholders are given.
In relation to the D2B time, the present-day approach of KRMC, the overall situation is positive: in general, stakeholders understand the importance of early actions and behave accordingly, although the degrees of awareness are different. However, as the observation demonstrated, the actual practice did not always comply with the AHA requirements. To obtain more knowledge of the issue, various open- and close-ended questions were used under appropriate circumstances. The in-service matters gave the chance to communicate with professionals, and sometimes patients and their families were asked about the D2B time.
STEMI Patients and their Families
It is proven that the process of reducing D2B time is closely connected with the early medical intervention that starts with patients’ or their families’ initiative (Wang, Wu, Lo, Liang, & Chang, 2015). Two frequent challenges should be addressed as the matters of priority: ignoring the alarming symptoms and using personal vehicles. As far as it was observed, the main concern of the medical center pertained to adults and people of increased age who tended to disregard the chest discomfort. As some patients’ family members admitted, they used their personal cars to deliver patients to the ED.
Therefore, KRMC views patient education as the main strategy to solve the problem. Risk groups are addressed by means of the technologies: educational resources are available, and nurses also collaborate with patients and explain to them the most significant rules. Still, there are many persons who need to advance their knowledge of cardiovascular diseases.
Emergency Department Physicians
As one of the duties of ED physicians is to prepare the Cath Laboratory and make sure nurses do the necessary procedures before patients are transferred there, D2B time depends on them (Zipperer, 2016). Because the direct professional communication between ED physicians and cardiologists can help save time, KRMC has recently introduced this innovation which proves to be effective. However, the personnel shortage turns out to be a difficulty. Judging by the answers given to the prepared questions, the specialists believe it is one of the most pressing problems because there are few nurses who prepare the laboratory and sometimes have to work longer hours.
Because the paramedics’ responsibility is to diagnose STEMI, their role in terms of reduction D2B time is vital: they can interpret patients’ symptoms in situ and provide other staff with this information (Lin et al., 2015). The KRMC paramedics not only handle high-technical equipment but also constantly improve their knowledge and skills. It is probably the most remarkable strength area of the medical center. Although the staff should enhance some aspects of their work, the whole picture gives ground to be optimistic. As the administration stated, the recent D2B time reducing was associated with the new equipment and its usage by the paramedics.
Another accomplishment of KRMC refers to STEMI teams results. While the national standards of 90 minutes are to be sustained, one should continue to work on D2B time reducing as far as feasible (Ellahham, Aljabbari, Mananghaya, Raji, & Al Zubaidi, 2015). Owing to the professionalism of the KRMC STEMI teams, the results of 60 minutes have been achieved. This index illustrates that the implementations prove to be effective, and one should focus on the work on that front. However, some difficulties are present: the teams composed of less experienced staff members sometimes fail to meet the time requirements. Taking into account the shortage of personnel, especially nurses, building a good STEMI team becomes challenging.
Finally, the changes in emergency departments organization can also lead to the reduction of D2B time. In this respect, the triage system is the first step: a triage nurse identifies the level of danger and makes corresponding decisions (Akbar, 2015). Despite the lack of employees, KRMC has enough nurses who are qualified specialists: observing them, I could see they acted accurately and promptly. Therefore, patients who needed immediate help always received it. Registration and wait times are the next steps, and the medical center can boast that the up-to-date technologies give the opportunity to manage documentation quickly.
Kendall Regional Medical Center has a good door-to-balloon time: it is less than the national standard prescribes. However, during the work at the ER and CVL departments, it was discovered that the requirements were not met in some cases. Patient ignorance, the shortage of personnel, and the need for training can be identified as the most important issues that should be addressed to improve patients’ health and raise the quality of services.
Akbar, T. M. (2015). Role of effective communication in management of medical emergencies. Anaesthesia, Pain & Intensive Care, 18(4), 329-331.
Ellahham, S., Aljabbari, S., Mananghaya, T. H., Raji, S. J., & Al Zubaidi, A. (2015). Reducing door to-balloon-time for acute ST elevation myocardial infarction in primary percutaneous intervention: Transformation using robust performance improvement. BMJ Quality Improvement Reports, 4(1). Web.
Lawson, W. E., Wilbert, L., Sokoloff, L., Srinivas, G., Viccellio, P., Dowdy, E.,… & Jeremias, A. (2014). Continuing to improve the D2B process. Circulation: Cardiovascular Quality and Outcomes, 7(1), 365-369.
Lin, H. J., Hsu, M. H., Huang, C. C., Liu, C. F., Tan, C. K., Chou, S. L.,… & Chen, C. J. (2015). Developing a mobile electronic D2B checklist for treatment of ST elevation myocardial infarction patients who need a primary coronary intervention. Telemedicine and E-Health, 21(4), 274-280.
Wang, Y. C., Wu, H. P., Lo, P. H., Liang, H. Y., & Chang, K. C. (2015). Impact of Prolonged Door-to-Balloon Times on the Diastolic Function in Acute ST-Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention. Acta Cardiologica Sinica, 31(4), 281-291.
Zipperer, L. (2016). Patient safety: Perspectives on evidence, information and knowledge transfer. New York, NY: Routledge.