Crozer-Chester Medical Center and Springfield Hospital were recently recognized as two of only four finalists for the 2008 Delaware Valley Patient Safety Award by the Delaware Valley Healthcare Council (DVHC) of the Hospital and Healthsystem Association of Pennsylvania (HAP) at the DVHC’s annual meeting in late October 2008.
Crozer’s award submission chronicled the medical center’s initiative to more quickly identify and triage heart attack patients who need life-saving primary angioplasties. Members of Crozer’s Cardiac Catheterization Laboratory, Emergency Department and Emergency Medical Services teamed up to develop a program that cut Crozer’s “door-to-balloon” time in half between March 2007 and June 2008.
Springfield’s submission outlined the creation of multidisciplinary evidence-based medicine rounds in the hospital’s Acute Care Center to ensure that patients receive appropriate care. Thanks to this program, the Acute Care Center exceeded 95 percent monthly composite compliance on eight evidence-based medicine initiatives.
“Congratulations to all of the Crozer-Keystone Health System physicians, nurses and other staff members who put so much time and effort into these outstanding patient safety initiatives. We are very proud to be recognized by the DVHC, but more important is the fact that our patients are receiving excellent care,” says Eric Dobkin, MD, vice president of Quality and Patient Safety.
A committee including quality and patient safety leaders from ECRI Institute, Independence Blue Cross, the Patient Safety Authority, the Philadelphia Department of Public Health, and the U.S. Department of Health and Human Services chose the patient safety award recipient and finalists from 25 nominated projects. Selection criteria included significant, sustained safety improvement; organizational commitment; innovation; and ease of replication by other hospitals and health care providers.
Crozer’s ‘Door-to-Balloon’ Initiative
The American College of Cardiology (ACC) and the American Heart Association recommend that patients suffering from a specific kind of heart attack known as an ST-segment elevation myocardial infarction (STEMI) have their arteries opened directly within 90 minutes of arriving at the hospital. A STEMI is identified by a major elevation of the tracing in the ST portion of an EKG study. Time is critical because the sooner the patient’s arteries are opened, the greater the chance of saving heart muscle and, therefore, the patient surviving.
The national average for door-to-balloon (angioplasty) time is about 100 minutes, according to researchers at Duke University. In March 2007, median time at Crozer-Chester Medical Center exceeded 100 minutes. In June of 2008, the median time was 55 minutes, more than 38 percent better than the ACC benchmark.
Crozer’s multidisciplinary team achieved this improvement by implementing several changes, including:
- Developing a more team-centered approach to moving the patient through the process. Members of the ED and Cardiac Cath Lab worked together as a team, conducting a case by case review, discussing what they were doing and why, and considering actions that could be taken to remove obstacles and reduce time. Through this effort, the two departments developed a strong, collaborative working relationship that led to significant improvement. “For example, instead of splitting the 90 minutes in half -- 45 for the ED and 45 for Cardiac Cath – they looked at the 90 minutes as a whole and figured out the best way to use it as a team,” notes Joan Marino, director of Accreditation at Crozer. “Nursing is an integral part of this team,” adds Mariano. “The nurses’ commitment to this initiative has helped to make it a success.”
- More quickly identifying patients experiencing STEMI.
- Developing a STEMI “box” that includes all the necessary supplies, medications, and protocols.
- More rapid assembly of Cardiac Catheterization Lab personnel to perform the PCI procedure, achieved by switching the decision to activate the team from the cardiologist to the Emergency Department physician. The team includes a nursing supervisor, radiology technician and security officer.
- Providing immediate feedback to staff regarding obstacles and data regarding the most current door-to-balloon times.
- Conducting an ongoing review of success and challenges.
- Conducting mock STEMI codes.
Springfield’s EBM Initiative
Springfield Hospital’s quality initiative addressed the hospital’s inconsistent performance in system-wide evidence-based medicine (EBM) initiatives, which ensure that Crozer-Keystone hospitals are delivering care that reflects the latest clinical evidence in such areas as acute myocardial infarction, congestive heart failure and pneumonia.
To improve these scores, the Acute Care Center nursing staff implemented daily EBM multidisciplinary rounds to review each patient’s care in reference to the established measures, as well as a general admission checklist and condition-specific checklists for every patient. The multidisciplinary rounds include an EBM Department representative, a pharmacist, case manager, house physician and a patient care nurse. In addition, the nursing staff has incorporated into their practice patient education and timely follow-up and feedback to staff and physicians through monthly performance reports and individual communication.
“This is a nursing-driven process,” says Lisa Schmidt, RN, Acute Care Center nurse manager. “Nurses organize and implement the daily rounds, review the checklists and, if an EBM measure hasn’t been completed, the nurse alerts the individual who needs to take care of it.”
Before checklists and rounds were instituted in October 2007, Springfield’s composite score for eight EBM projects ranged from 78.4 percent to 96.2 percent. After implementation, the overall composite score from November 2007 through May 2008 exceeded 95 percent in all projects.
Earlier in 2008, Springfield Hospital was honored with a 2008 VHA Leadership Award for Clinical Excellence for meeting and exceeding national performance standards for clinical care in the prevention of ventilator-associated pneumonia.
The DVHC advocates for southeastern Pennsylvania hospital and health care-related organizations, including more than 50 acute and specialty care hospitals and health systems, 30 facilities providing inpatient behavioral health services and 20 facilities providing rehabilitation. Additional information is available online at www.dvhc.org.
Michael Adesman, M.D., director of the Cardiac Catheterization Laboratory
Brian Buchy, clinical specialist, Cardiology
Michele Gillespie, R.N., administrative director of Cardiology
Ancil Jones, M.D., chief of the Section of Cardiology
Kathy Lehman, RN, B.S.N., ER3 outreach
Joan Marino, R.N., MBA, director of Accreditation
Robert Reeder, director of EMS
Susan Ridinger, R.N., Emergency Department nurse
Joseph Saunders, president of Crozer
Sharon Scott, R.N., M.S.N., EBM program coordinator
Connie Sonder, R.N., M.S.N., administrative director of Nursing
Eileen Young, R.N., M.S.N., assistant vice president of Clinical Utilization and Outcomes
Nancy Young, R.N., BSN, director of Risk Management
Team leader: Lisa Schmidt, R.N., nurse manager, Acute Care Center
Caroline Haggerty, R.N., EBM program coordinator
Suzanne Jenkins, R.N., EBM program coordinator
John Krauss, R.Ph., staff pharmacist
Millie Long, house physician
Mina Marks, M.D., house physician
Sharon Scott, M.S.N., R.N., EBM program coordinator
Jo-Zetta Shawl, M.S.N., R.N., director of Patient Services
Denise Simpson, R.N., case manager
Eileen Young, M.S.N., R.N., assistance vice president of Clinical Utilization and Outcomes