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Budge Smith, MD, FACCCath Lab Medical Director, PRMCE
Western Washington Medical Group CardiologyEverett, WashingtonOctober 2009
Ongoing education effort to public and clinical staff
EMS Outreach program EKG interpretation Rapid transfer of field information to ED,
including electronic transmission Direct activation of cath lab by verbal report
from the field Potential expense with regard to false positives
Limit door to EKG time to <10 minutes If triage is full, move prioritized patient to
gurney and perform EKG in hallway Activate senior nursing staff
Designated STEMI nurse on each shift Produce and use STEMI cart Limit extraneous activities
Limit labs to I-stat labs, creatinine, hgb No CXR unless indicated
July, 2008 – June, 2009
CVL staff to ED to transport and receive report 4 staff on call Cross training is important so room set up occurs while
patient is being transported IV and groin pre done by all staff Physicians help set up, transfer, and drape patient
when applicable Do not wait on dictation Do not wait for consent
Life threatening situation Patient has received sedation Family may not be available
Dedicated information system to be able to record accurately Interface between hemodynamic and information
system Physician notes time of dilation for accuracy
and consistency Close the feedback loop with system-
generated patient report
NRMI data ACTION Data
NRMI data ACTION Data
Ou
tco
me
(%)
* Bleeding censored at time of CABG
Risk Adjusted Mortality- Providence = 4.0%- Nation = 6.3%- Top 10% = 5.4%
NRMI data ACTION Data* Risk Models have changed over time
360 new beds Opening Fall 2011