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Discussion in 'Emergency Medicine' started by paramed2premed, Sep 27, 2014.
How many hospitals are trying to hit 60 minutes D2B, not just the 90 minute quality measure?
60 minutes? That's so "2014."
If you want to be cutting edge in 2015, are you ready.....
90 minutes? 60 minutes? Pffft! 59. There is none lower.
Our goal is 45 minutes. EMS activates in the field and patients go straight from ambulance bay to cath lab. (EKG is reviewed by cardiology or ER physician prior to direct to cath lab, but the team is activated during the night based on EMS interpretation.)
What if someone comes out with 58 minutes?
We beat 60 minutes easily. Sometimes they go from EMS, through the ED, right into Cath lab during the day.
Our Door to Doc eval time is under 10 minutes. I never thought this was possible but we avg less than 10 min from the time someone comes up to triage to when a doc sees them.
That's humanly impossible, like the 6 blade razor, breaking the sound barrier, the 4 minute mile or putting a man on the moon. It's impossible. Like with those impossible barriers, "studies show" that going below 59 minutes causes systems to grind to a halt, cath-lab equipment and ED stretchers melt down from the stress and all myocardium explodes.
But I am here to testify! that with a little better door to doctor times, more focus on metrics and more exceedingly complex EMRs and just a touch more physician meaningful-use requirements.....
Who knows? Anything might be possible!
I have a dream. A dream that someday doctors will be WORTH the millions a year we pay them to amputate healthy feet and needlessly yank tonsils, and that they will be able to call an MI alert BEFORE a patient even starts having chest pain and comes to the hospital. Wait.... hold on.... I'm getting an instant message from Debbie Wasserman-Schultz.... ok ok.... yes I do like my family.... yes it would be a shame.... ok ok got it.... excuse me everyone, let me try this again....
I have a dream. A dream that someday PROVIDERS will stand hand-in-hand, and that DNP's will be able to call an MI alert BEFORE a patient even starts having chest pain and comes to the hospital, because obviously those greedy doctors are too stupid to do it.
I bet 1 min !
Can I just say I love the proliferation of process-oriented quality measures. In an age when it's still fringe to rail about the lack of patient oriented outcomes in trials, the powers that be have stolen a march on all of us. In order to receive Chest Pain, CVA, Heart Failure accreditation (and eventually trickling down to JC accreditation), you are beholden to meeting time-stamped standards that have never been proven to improve things for the patient. A significant number of STEMIs are coming in with hours of continuous pain or already have Q-waves on the EKG. It seems ridiculous to me that someone who infarcted yesterday will see a benefit from going to the lab in 60 vs. 90 minutes. Similarly, does the head CT on a patient that doesn't meet tPA criteria really need to be done within 45 minutes of arrival?
In some ways we are a hypocritical as ED docs because the rise of such exacting standards have made our ability to disposition significantly easier. I don't miss the days of having to argue with a cardiologist about coming in on a delayed presentation STEMI or when the EKG shows STEMI but the patient has atypical symptoms. But my medicolegal comfort is probably coming at the cost of a small but measurable number of iatrogenic complications from unnecessary or unoptimized procedures and from missed alternative diagnoses due to unavailable diagnostic tests because of the time crunch. For example, raise you're hand if you've ever sent a hyperkalemic dialysis patient to the cath lab because of EKG changes from the hyperK. <<raises hand>>
Shortest one I've had recently is 15 min's. EKG dx'd the MI in urgent care. They got ASA, nitro, morphine and beta blockers all going. Came in, confirmed the repeat EKG, shot a CXR, quick physical, off to cath lab they went.
7 minute ABS!
Wow, ok, 45 minutes as an institutional goal. That's pretty ambitious.
I'll leave aside the issue of whether sub-90, sub58, or sub-45 minute times are medically indicated (the balllyhooed recent NEJM study certainly dumps some cold water on that process-oriented measure!).
So, no one has heard of any official quality measure that is sub-60 coming down the pike?