Transcript Total Knee and Hip Replacement at Maury Regional Medical Center

2015 Annual Tennessee STEMI
Meeting
October 2, 2015
Kevin Maquiling, M.D., FACC
Cathy Malone, MMHC, BSN
Middle Tennessee Regional Showcase
Financial Disclosure: none
Unlabeled/Unapproved Disclosure: none
Maury Regional Medical Center
 Largest hospital between
Nashville, TN and Huntsville, AL
 275 bed facility with a medical
staff of more than 200 physicians
and 2,000 employees
 Serves a region of more than a
quarter of a million people in
southern middle Tennessee
Maury Regional Medical Center
Service Area
Maury Regional Medical Center
MRMC is proud to have been
recognized for its quality of care
and operations
Services include:
 Cancer Center
 Emergency Services
 Heart Center
 Neonatal Intensive Care
 Neurology and Neurosurgery
 Orthopedic Services
 Surgical Services
 Women’s Center
Quality of Care
 Recent recipient of the TNCPE 2014
Excellence Award
 2015 - Formally recognized as a “Planetree
Designated®” Patient-Centered Hospital
It’s one of 28 hospitals in the U.S. and
the first in Tennessee.
The Joint Commission
 Disease-Specific Care for Inpatient Diabetes
 Disease Specific Care for Joint Replacement - Hips
 Disease Specific Care for Joint Replacement – Knees
 Disease Specific Care for Sepsis
 Disease Specific Congestive Heart Failure
MRMC’s Team
2014 STEMI - Median Time to PCI
Median time to PCI
Goal < 60 Min
76
80
68.5
70
60.5
50
40
30
53.0
52.0
54.0
52.5
53.0
45
43.0
35.0
20
31.0
10
0
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
2015 STEMI - Median time to PCI
Median time to PCI
Minutes
Minutes
60
90
80
70
60
50
40
30
20
10
0
61.5
48.0
48.5
49.0
34.0
JAN
FEB
MAR
APR
MAY
33.0
JUN
Success # 1
Community Wide Education on calling 911
…………and a personal story
EMS Arrival vs. Walk-In
6
7
6
EMS
4
Walk-Ins
5
4
5
2
2
2
5
2
3
3
3
2
4
4
3
3
2
1
Jul-14
Aug-14
Sep-14
Oct-14
Nov-14
Dec-14
Jan-15
Feb-15
Mar-15
Apr-15
May-15
Jun-15
Success # 2
Lean Project:
Improving Door In to Door Out (DIDO)
Wayne Medical Center
Issue and Background
 Issue:
When a STEMI is diagnosed at Wayne Medical Center (WMC),
there is a delay in the transfer to Maury Regional Medical Center
(MRMC).
 Background:
Once a STEMI is diagnosed, the time it takes to get the
medications from pharmacy, call for transport, wait for an
accepting physician, finish the paperwork and get the patient
out the door is greater than 50 minutes.
Current Condition
 Everyone involved brought together
 STEMI transfers reviewed for areas of opportunity
 Each OFI broken down into manageable categories
 Opportunities identified:
•
•
•
•
•
•
Delay: waiting on accepting physician
Delay: waiting on cardiologist to give med orders
Delay: using helicopter to transfer patients
Delay: RN does not have medications readily accessible
Delay: RN hold up transport of patient to give report
Delay: RN (after hours) gives report to ED charge nurse if cath team
not present yet
Problem Analysis
 WMC ED physician waits on cardiology to call back before
starting transfer of patient.
Why? Not all ED physicians aware of one call acceptance at MRMC
Why? Turnover of ED physicians at WMC = new ED physicians
 WMC ED physicians wait to speak with cardiologist prior to
initiating medications to STEMI patient.
Why? Not aware of transfer protocols established by MRMC
cardiologists.
Problem Analysis (continued)
 WMC ED physicians use Air EMS to transport STEMI patients.
Why? They think it is faster than ground transportation
Why? New ED physicians that do not live in area are not aware of
time requirements of flying patients and logistics of transfer
at MRMC.
 RN does not have easy access to protocol medications or
supplies.
Why? Some stocked in accudose, others in pharmacy.
Why? Not enough room in accudose for rarely used medications.
Problem Analysis (continued)
 RN delays transfer of patient to give report to MRMC
Why? In the past, always told had to speak to accepting RN first.
Why? That was the practice.
 RN calls ED charge nurse after cath lab hours to give report
Why? Cath lab personnel not on site yet.
Why? After hours, they are on call.
Target Condition
 Eliminate delays and make it easier for WMC to transfer STEMI timely!
 Call is made to Wayne County EMS at the same time MRMC is called to
notify of STEMI transfer.
 Protocols are initiated by physician – RN uses STEMI kit with all
medications and supplies in accudose.
 Patient is transferred by ground. All paperwork is faxed after the patient
leaves the facility.
 Upon arrival of cath team, one member calls WMC and receives report
from RN.
Countermeasures/Implementation Plan
 Education to WMC staff regarding one call acceptance, MRMC transfer
medication protocols, Door In/Door Out goal of less than 30 minutes and
preferred use of ground transport.
- implemented by Dr. McMurray by January 31st, 2014.
 Establish STEMI kit in Accudose with all medications and supplies
needed for transfer STEMI to MRMC.
- implemented by Karen Johnson and Brenda Bishop by February 1st, 2014.
 Meet with Wayne County EMS director to establish protocols for
for STEMI transfers to MRMC.
- implemented by Karen Johnson and Brenda Bishop by February
1st, 2014.
Countermeasures/Implementation Plan
 Educate cath lab staff at MRMC of calling for report upon arrival.
- implemented by Brenda Bishop by February 1st, 2014.
 Educate House Supervisors to prompt WMC ED physicians to expedite
transfer of STEMI patients: not to wait for cardiology to call them back
and to fax paperwork after patient has left facility.
- implemented by Brenda Bishop by February 1st, 2014.
FOLLOW UP
March 1st, 2014 – Brenda, Karen and Dr. McMurray met to discuss any other
implementations or needs concerning STEMI patients.
Wayne Medical Center Door In Door Out
2013 - 2015
80
70
70
60
50
44
48
40
30
29
30
29
23
29
19
25
20
15
16
10
9
0
Mar 2013
Sep 2013
Dec 2013
Feb 2014
Mar 2014
Jul 2014
Aug 2014
Sep 2014
Oct 2014
Jan 2015
Apr 2015 May 2015
Jul 2015
Challenges/Works in Progress
 Community Education
 Reducing DIDO times at the other transferring
facilities in our region.
“If everyone is moving forward together,
then success takes care of itself”
- Henry Ford
Thank You!!