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Northwestern Medicine researchers work to improve heart attack response time
Date:4/29/2013

TEMI patients."

Khare and his team utilized a proactive risk assessment method of failure mode, effects and criticality analysis (FMECA) to evaluate door-to-balloon time process at Northwestern Memorial. Pulling together a group that included emergency department and cardiac catheterization laboratory (cath lab) staff, as well as hospital leadership, the researchers mapped out the process from when a STEMI patient arrives in the emergency department to when PCI occurs in the cath lab.

"FMECA is a commonly used risk-assessment technique that has proven successful in high risk industries including nuclear power and aviation," explained Khare. "We modified this technique to fit a clinical setting. Our team included everyone who would respond when a patient with a STEMI arrives at the hospital emergency physicians and nurses, EKG technicians, and the entire cath lab team from cardiologists to nurses, and even the secretary who answers the phone and takes the patient's information. Together, we were able to identify and evaluate 50 potential issues that could lead to a failure in achieving the goal door-to-balloon time of 60 minutes."

The group identified the causes of the process failures then ranked each based on its frequency and consequence, eventually categorizing 12 as high-risk steps. This information was then used to determine where improvements could be made when caring for STEMI patients. Using process improvement strategies and system redesign, one change put into practice by the team was to get an electrocardiogram (EKG) at arrival for any patient who came to the emergency department and stated they had chest pain.

"We found that there were factors which could cause delays in getting the EKG in our system, so we changed our operations so that the EKG was done when the nurses were getting the patient's vital signs," said Khare.

By identifying risks and implementing changes in process, the team achieved signifi
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Contact: Megan McCann
memccann@nmh.org
312-926-5900
Northwestern Memorial Hospital
Source:Eurekalert

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