IHS Best of the Best Series: AMI from IHI Pursuing Perfection

“It Takes Leadership”

Design Team Make-up and Functioning

• To achieve high reliability results requires:
– An investment of time and money
– Commitment to the use of the best evidence
– Organized approach to the design task
– Cooperation among clinicians
• A cross-functional team:
– Physician and nursing representatives from the ED
– Cardiology
– Many other areas in the hospital
– Administrators with responsibility across the organization

Design Team Make-up and Functioning

• Required enhanced coordination with the three community hospitals admitting to its:
– Emergency department
– Cath lab
– Coronary intensive care unit
• Addressed each micro-system through which an AMI patient must pass
– Created a shared vision: reduction in acute myocardial infarction mortality
• Involved physicians from the ED and Cath Lab

Design for rapid flow of care from patient arrival at ED

• Hospital EMS technicians perform 12-lead electrocardiograms (EKGs) without transport
delays and send results electronically while en route to hospital
• On patient arrival at ED, EKGs performed within 15 minutes of arrival
• Standard communication process
– Simultaneously alerts all when EKG shows ST elevation
• Essential physicians and staff
• ED physicians and nurses
• Interventional cardiologist
• Cath lab staff

Design for reliable compliance with ev-based Dx & Tx

• EMS standardized:
– symptom recognition
– advanced cardiac life support protocols and procedures for transport to appropriate
facilities
• Standardized approach to care:
– history taking
– acute myocardial infarction symptom recognition
– medication orders, and ASA administration
• Retrospective case review when care does not match the evidence
– identify areas of further system improvement
• “All or nothing” used to measure compliance with the evidence
– Care scored 1 or 0 on whether care confirms perfectly to the evidenced-based
standards
Best of the Best in AMI – Pursuing Perfection
“It Takes Leadership”
Page 2

Perfect Care: Design Principles: Physician-Led, Evidence-Based, Data-Driven

Leadership Commitment:
• Strategic plan focuses on quality, physician partnership,
• Service line, fiscal and people development
• Strategic plan drives the specific goals of the executive and leadership team
• Progress towards goals are monitored, annual incentive
– Bonuses based on successful completion of goals
• System problems are solved during the many weekly CEO-led team meetings
• Outcome data is continuously shared with the staff, leadership and board of trustees
• Focus of communication is organized in the “Board Calendar”