Case Study: Goshen General Hospital – Heart Attack Victims Receive Life-Saving Treatment Faster

By Chris Heim

Goshen General Hospital is a community hospital serving the 32,000 people of Goshen, Ind., that staffs more than 150 physicians across nearly twenty specialties. The hospital is proud of its high standards of care and typically scores in the ninetieth percentile for JHACO accreditation. Each year, the staff provides care to approximately twenty patients suffering acute heart attacks.

Challenge: In 2006, the American Hospital Association and the American College of Cardiology released new guidelines for how quickly hospitals should provide care to heart attack patients. They advised that the “door-to-inflation time” (aka “door-to-balloon time”) should be 90 minutes or less. This means that a patient should be registered, evaluated, and ultimately in an operating room receiving potentially life-saving catheter treatment (the balloon) within ninety minutes. Shortly after these guidelines were released, the Centers for Medicare and Medicaid, as well as JCAHO, followed suit and revised their standards to 90 minutes.

All hospitals that provide care for heart attack patients must track their door-to-inflation time. In 2006, the staff at Goshen General Hospital began taking a hard look at improving their process for treating heart patients. In particular, they considered technological advancements that could speed the flow of information needed to manage these situations, thereby saving patients from heart muscle damage and related long-term disability– if not saving their lives.

Goshen’s door-to-inflation time was averaging 129 minutes. One of the reasons it took this long was that contacting all the necessary personnel was a manual process requiring operators to reach some staff members by phone and others by pager. Andrea Daniels, RN, BSN, and director of Cardiovascular Servicesat Goshen, knew that the dedicated staff was up to the task of improving care for these patients. “We’re on a mission to provide excellent patient care. If my mom came in as one of our heart attack patients, I wouldn’t want her waiting even 90 minutes before care is administered just because we’re making calls,” she said.

Objective: Goshen set out to reduce its 129-minute door-to-inflation time to well below the 90-minute guideline and help patients receive treatment faster. The hospital team analyzed their “code STEMI” (segment elevation myocardial infarction) process, the protocol used for heart attack patients. It includes various activities that must occur to transfer critical information quickly among thirty hospital staff members as patients move from registration through the emergency department and ultimately into the surgical suite, where the blocked artery is ballooned.

The team worked to improve their code STEMI handling through a process that included:

  • Identifying and evaluating each of the communication and action steps required during a code STEMI
  • Evaluating technology and process options to speed or eliminate steps
  • Review and trial of the new plan, making all involved clear on their roles
  • Refining the process based on real-world situations

Solution: Daniels formed a multidisciplinary team to get the right people communicating about the project. “When something new needs to happen at the hospital, we really collaborate to make it work,” she said. “For code STEMIs, there were a multitude of calls being made that didn’t need to be. A lot of time was being wasted.”

Daniels’ plan was to examine the steps in light of suggestions featured in a publication for cath lab professionals. “This article identified improvements that could shave precious minutes off the door-to-inflation time,” she said. “For example, a centralized page can save 13.8 minutes.”

Daniels and the team implemented several streamlined procedures in 2006 and 2007 before looking at centralized paging options. When the time came, they selected e.Notify, the emergency management and notification system from Amcom Software. The system, used by many of the leading hospitals in the United States, enables two-way communication that is documented, auditable, and repeatable. It accommodates emergency-related variables regarding which personnel should be notified and via what device, as well as what information to relay. The application enables two-way response to pages with automatic escalation to predetermined staff members if those initially contacted do not respond. “After we got [the system] in place, we performed a drill to get our process solidified. All went well, and everyone was excited with the improvements,” Daniels said.

Results: By 2008, the team at Goshen had reduced its door-to-inflation time to an impressive seventy-one minutes through the new system and related communication improvements. Daniels indicates that it “has improved our communication and efficiency. I responded to the first code STEMI we had after implementing the system. Everyone just came on cue. With the two-way response and escalation abilities, it was amazing how quickly it happened. There were real benefits for the patient.”

Now, when an ER patient’s electrocardiogram indicates a heart attack, Goshen ER staff activates the highly efficient code STEMI alert process. The ER secretary initiates one code in order to reach thirty people simultaneously with specific instructions based on their role. These members include the cath lab staff, house supervisor, ICU shift coordinator/nurses, attending cardiologist, cardiovascular coordinator, ER director, cardiovascular director, ER shift coordinator, and x-ray/imaging and lab technicians. When they receive notification, everyone immediately prepares for next steps and responds appropriately. The house supervisor also knows the system will track who has responded and take follow-up action if needed.

“We meet after each incident to work the glitches out of our process,” Daniels said. “For example, after the first one, we added the option to cancel an alert once it has gone out, in case no intervention was needed. The benefits are wonderful. It all just happens now. It even saves time on the staffing and registration end. Ultimately, our patients will receive faster care, and we’ll be able to save more lives.”

For more information call Amcom at 800-852-8935.

[From the April/May 2009 issue of AnswerStat magazine]