Cardiovascular diseases or Acute Myocardial Infarction (AMI) requires acting on critical time to save the patients’ lives. A DMAIC project was undertaken at Deaconess Health System in Evansville, Indiana, USA to assess the throughput time from the moment the patient came at the emergency, with an AMI, to the inflation at the lab.
There were various reasons for the Green Belts and the hospital to take up the door-to-inflation study and improvement. It could increase better outcomes for patients, increase the Percutaneous Coronary Intervention (PCI) volume, and help Centers for Medicare and Medicaid (CMS) for its future endeavors.
Once the problem was defined (AMI targets not meeting the CMS specifications), a project charter was drawn out and 4 Green Belts were deployed to take care of the improvement process. A cross functional team from related departments was also included for data and expert judgment.
The DMAIC project then moved on to Measurement and Analysis, wherein the team chalked out a value stream map with each of the six sub processes in the door-to-inflation stream. The problem areas identified were the cardiologist and the cardiovascular lab team not getting the notification at the same time, calling the non-interventional cardiologist before the interventional cardiologist, and absence of a consistent process.
As per the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), AMI-8 patients should move from door-to-inflation in 120 minutes. The Green Belts, along with the Champions and the Sponsors, etched out a plan to give reperfusion or first inflation to 50% of the patients within 60 minutes of arrival, to 75% of patients within 90 minutes of arrival, and to 100% of patients within 120 minutes of arrival.
Need for the non-interventional cardiologist was removed from the process, and DMAIC helped standardize the process. The staff was trained, the system was documented and control mechanisms were put in place. The results showed that the first inflation within 60 minutes increased from 13 to 40 %., within 90 minutes from 51 to 69%, and within 120 minutes from 85 to 96%.