|Millard Fillmore Gates Circle Hospital is a 189-bed acute care medical center located in Buffalo, New York. An affiliate of the University of Buffalo School of Medicine and Biomedical Sciences and major component of Kaleida Health System, Millard Fillmore Gates Circle offers treatment in a wide spectrum of clinical inpatient departments and outpatient programs.
To improve its door-to-balloon D2B times, Millard Fillmore Gates Circle focused improvement efforts on its data collection system and mechanism for prompt data feedback. Prior to improvements, the hospital collected the total D2B time, instead of examining intervals within the D2B process, and the data reported was abstracted long after the case. This system did not provide an adequate mechanism to identify opportunities for improvement.
Over the course of a few months, a team at Millard Fillmore Gates Circle developed a data collection tool to break down D2B times by intervals and created a system to provide data feedback to the cardiovascular team in a timely fashion. The intervals for the data collection tool include: door-to-ECG; ECG read by the emergency department (ED) physician; time of the cath lab call to activate; and response time of the cath lab team. This tool is attached to the Chest Pain Order Sheet in the ED and is used when a patient exhibits symptoms consistent with acute coronary syndrome. If STEMI is confirmed, the hospital STEMI protocol is followed and times are recorded in the ED and cath lab until the balloon is inflated.
The data collection sheets are faxed to the director of Quality Improvement Cardiac Services soon after the presentation and intervention and the data is distributed to the directors of the ED, cath lab, and Cardiovascular Services within 24 hours of receipt. If delays in treatment are identified, the directors meet to analyze the data, identify whether an improvement opportunity exists and formulate an actionable plan to improve performance.
Collection of the data provides not only opportunities for quality improvements but also opportunities to recognize staff efforts. The hospital has a recognition program that presents ED and cath lab staff members with a "certificate of efficiency" when they achieve a D2B time of 90 minutes or less, the recommended standard of care. By all accounts, staff members have welcomed the recognition program, going so far as to request that the certificates identify the D2B by date and time so that they can create some competition between shifts.
The effort to create an effective data collection system was not easy. Because the hospital currently collects all D2B times manually, the times must be entered into a computer system. Given the nature and volume of work in the ED, some members of the staff were reluctant to take the time to enter the D2B times for each patient. However, the senior administration, cardiac quality department and cath lab director saw the data issue as critical to improving care at the hospital and persistently requested staff compliance.
The D2B improvement efforts resulted in a culture change at the staff level. Since the hospital began its improvement process, its median D2B time has dropped to 55 minutes with 85% percent of STEMI patients achieving times less than or equal to 90 minutes. The hospital is now working with local EMS to expand its measures to pre-hospital components.
Thank you to Michael Campo and the entire team at Millard Fillmore Gates Circle Hospital for sharing their impressive story. For more information on Millard Fillmore Gates Circle’s experience, please contact Michael Campo at firstname.lastname@example.org.