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My practicum project involved the implementation of an evidence-based practice strategy at Kendall Medical Regional Center to reduce the Door to Balloon Time in STEMI Patients. The need for the intervention program was caused by a high DTB time at the facility as reported by patients. The implementation procedure was a multi-step plan that involved a vast part of the facilitys personnel in the intervention process.
Rationale
Cardiovascular diseases are extremely prevalent all over the world, including the United States. According to the statistics provided by the Centers for Disease Control and Prevention (CDC, 2016), heart diseases are the primary cause of death both in male and female patients: About 610,000 people die of heart disease in the United States every year (para. 1). Moreover, about 735,000 people in the U.S. experience a heart attack every year (CDC, 2016). CDC (2016) states that early action is the key to preventing deaths due to heart attacks and cardiovascular diseases, which means that both the patient needs to recognize the symptoms and get to the hospital as soon as possible and doctors are required to respond promptly and without any delays. Menees et al. (2013) confirm: Current guidelines for the treatment of ST-segment elevation myocardial infarction recommend a door-to-balloon time of 90 minutes or less for patients undergoing primary percutaneous coronary intervention (PCI) (p. 901). Other studies suggest that the reduction in DTB time for cardiovascular patients improves the possibility of a positive outcome (Ellahham, Aljabbari, Mananghaya, Raji, & Zubai, 2015). Nevertheless, some hospitals do not adhere to these requirements, which may impair the quality of the treatments provided and cause health implications that could be avoided. Implementing Evidence-based Practice Strategy could help to improve the situation in these institutions, as it is focused on integrating current knowledge, such as scientific advancements and practice experience, into treatment approach targeting individual patients. Thus, the introduction of EBA could provide nurses with the information about the necessity for decreasing DTB time and the latest practices for doing so, while at the same time allowing them to tailor the approach under the influence of practice-specific factors, including size, the number of doctors available, specifications of the equipment, and so on.
Facility Information
Kendall Medical Regional Center is located in Miami, Florida. It is a medium-sized hospital with 417 beds, over 700 physicians, and 1700 employees in total. It is a comprehensive care facility, providing qualified all-day help for a wide range of diseases and conditions, including those affecting the cardiovascular system. The hospital includes a variety of medical, trauma, surgical, behavioral health, and diagnostic facilities and has been nationally recognized by a range of awards, such as Thomson Reuters 100 Top Hospitals, Health Grades Award for Clinical Excellence, and others. Among the hospitals main priorities are reducing the number of medical errors and ensuring the safety of patients at all stages of treatment. Moreover, the hospital is currently undertaking efforts on enhancing timeliness in emergency care, which means that some practices for reducing DTB time must be already in place. Nevertheless, need assessment identified that there are still some gaps to be fulfilled: for instance, even though the average door-to-balloon time was less than the prescribed average of 90 minutes, it was discovered that the requirements were not met in some cases. Moreover, the needs assessment indicated that, in some cases, there were delays between the patient arriving at the A&E and reaching the CVL department, which is why there is a certain need for evidence-based practice to reduce the share of delays and promote better patient outcomes. An adequate time of completion for such a large-scale practice should be between three and five months.
Discussion
Resting on the above-mentioned information, we could state that the decrease of door-to-balloon time becomes one of the major goals for the given facility. Previous investigations on this very issue showed the direct correlation between outcomes and DTB showings. It means that if door-to-balloon time increases, the final result might suffer. For this reason, the project outlines the main ways that could be explored to implement the new approaches which might help to attain success and reconsider the existing approach. First, we revolve around organizational and political issues that should be improved. This aspect involves additional staff training and the elimination of individualistic behavioral patterns of the team members to foster collaboration and increase the efficiency of teamwork (Jordan & Caesar, 2016). Therefore, the overall change strategy covers all vital issues that should be considered when implementing a new practice. Moreover, communication is given special attention as it is taken as a key to successful improvement.
Furthermore, the implementation plan also presupposes different actors engagement in the project. It means that the executive management team of the hospital should provide its support to staff in reorganizing the basic elements of this very medical establishments functioning. The management team could be considered the main shareholder which is interested in the creation of an appropriate approach to implementing the strategy needed to decrease door-to-balloon time and contribute to the improved outcomes (Thylen, Ericsson, Angerud, Isaksson, & Lawesson, 2015). Executives should show their commitment by underlining the great importance of the suggested task and attending report-out sessions related to the project (Ferguson, Briesch, Volpe, & Daniels, 2012). Only in case, the cooperation between the staff and managers who can impact the hospitals functioning is aligned, we could speak about the further improvement of the situation.
Nevertheless, Kendall Regional Medical Center (KRMC) should be ready to meet new demands that come from the nature of the change process initiated to improve the quality of suggested services and the state of patients health. For this reason, there are certain requirements for the facility as it lacks the most innovative systems and approaches needed to align its efficient functioning. However, considering the main aim of the above-mentioned project, we should state that KRMC has already initiated several efforts to decrease DTB time and save patients with cardiovascular diseases. However, there is still much to be done as the given healthcare unit still lacks improved collaboration and comprehending the basic approaches to the reduction of DTB time and its impact on the state of patients.
Altogether, we should state that at the moment KRMC passes through the period of change and tends to implement innovative approaches to decrease DTB time and help patients suffering from different cardiovascular diseases. Besides, the importance of the given goal comes from the complex character of these problems and threatening statistics related to the issue. Several basic areas should be altered in terms of the given project which are related to the sphere of communication, cooperation, management, organization, and political issues.
References
Centers for Disease Control and Prevention (CDC) (2016). Heart disease facts.
Ellahham, S., Aljabbari, S., Mananghaya, H., Raji, J., & Zubai, A. (2015). Reducing door-to-balloon time for acute ST-elevation myocardial infarction in the primary percutaneous intervention: Transformation using robust performance improvement. BMJ Quality Improvement Reports, 8(4), 1-4.
Ferguson, D., Briesch, A., Volpe, R., & Daniels, B. (2012). The influence of observation length on the dependability of data. School Psychology Quarterly, 27(4), 187-197.
Jordan, M., & Caesar, J. (2016). Improving door-to-needle times for patients presenting with St-elevation myocardial infarction at a rural district general hospital. BMJ Quality Improvement Reports, 5(1), 1-9.
Menees, D. S., Peterson, E. D., Wang, Y., Curtis, J. P., Messenger, J. C., Rumsfeld, J. S., & Gurm, H. S. (2013). Door-to-Balloon Time and Mortality among Patients Undergoing Primary PCI. The New England Journal of Medicine, 369, 901-909.
Thylen, I., Ericsson, M., Angerud, K. H., Isaksson, R.-M., & Lawesson, S. S. (2015). First medical contact in patients with STEMI and its impact on time to diagnosis; an explorative cross-sectional study. BMJ Open, 5(4).
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