Door to Balloon $($Percutaneous Coronary Intervention $($:$[PCI{]}^2\}-$ Case for Chapter $7$

Robert Casanova

Part One

XYZ Memorial Hospital is part of a local hospital system. This hospital's Quality Management Committee performed a retrospective review of $90$ cases from patients with signs and symptoms of heart attacks. Data were collected from Emergency Department records and Cardiac Catheter Labs $($Cath Lab$)$ over the past year; these data are shown in FIGURES $18-4,18-5,$ and $18-6$ below. It was determined that $32\%$ of cases exceeded

$120-$minute Door to Balloon $($PCI$),$ and $68\%$ exceeded $90$ minutes Door to Balloon. The original target time from Emergency Department $($ED$)$ admission to PCI was $120$ minutes but the revised target is now $90$ minutes or less.

Part Two

The data were analyzed to determine potential root causes of delays to PCI.

FIGURE $18-4$ Number of Patients by Length of Admitting Times from ED Arrival to PCI

$2PCl$ is the first$-$time documentation of crossing the lesion by either the wire, balloon, or stent

Chapter $18$ Health Care Management Case Studies and Guidelines

FIGURE $18-5$ Amount of Time from ED Admission to PCI by Hour of the Day

FIGURE $18-6$ Number of Patients $($Cases$)$ Admitted to the PCl in over $90$ Minutes by Day of Week

Potential factors that did not appear to be driving Door to PCI time over $90$ minutes included:

Time to First ED EKG, $86\%$ were $5$ minutes or less.

Start of PCI procedure to "crossing the lesion" $($which is when myocardial infarction blockage is at least partially relieved$).$

Data analysis resulted in a median of $18$ minutes, Standard Deviation $15$ minutes.

Potential factors that indicated possible sources of delay.

Hour of the Day

Most delays to PCI were between the hours of $6$:$00$ a$.$m$.$ to $4$:$00$ p$.$m$.$

$510$

Chapter $18$ Health Care Management Case Studies and Guidelines

What might be the incentives and disincentives for taking ED on$-$call?

List possible changes to the on$-$call schedule that might improve the availability of the invasive$/$interventional cardiologists.

What should be considered if there were not enough invasive$/$

interventional cardiologist willing to ED on$-$call?

What might be short$-$term solutions to this issue that can be implemented prior to longer term solutions?

Does the Cath Lab's capacity and capability affect this situation?

Please provide answers not directions or recommendations