2012 Quality Improvement Project:
Thrombolytic Therapy for STEMI in the Emergency Department

Project Goal: Achieve 100% compliance with timely administration of thrombolytic therapy in patients with an ST Segment Elevated Myocardial Infarction (STEMI).

Time Frame: June 2011 – present

Project Summary: In the first 9 months of FY 2011, there were 5 missed opportunities for administering thrombolytic therapy within 30 minutes of arrival to the Emergency Department for patients with an ST Segment Elevated Myocardial Infarction (STEMI). Administering Thrombolytic therapy within 30 minutes of arrival can have a dramatic effect on patient outcomes and survival rates. As such, the ED staff developed a plan to address these failures in July, 2011 that included the following:

• Improvement in physician orders for STEMI To prioritize thrombolytic administration and reduce the number of steps required for intervention
• Creation of a unique “Lytic” box containing physician orders and medications to treat STEMI
• Expectation that all ED staff and physicians are responsible for ensuring thrombolytics are provided to patients who meet criteria within 30 minutes
• The adoption of a team approach to recognition and initiation of treatment. As such, when a STEMI is suspected by a nurse or physician, he/she issues a “STEMI ALERT” which triggers the following actions:
  • The ED Tech sets a timer to track the 30 minute window from time of arrival to time of thrombolytics
  • The RN immediately takes the “Lytic” box to the patient’s bedside
  • The RN and physician meet at the bedside to discuss administration of thrombolytics
  • Once the decision to give thrombolytics has been made, the nurse immediately administers them to the patient

Since this plan was instituted at the end of FY 2011, 6 patients have been treated in the ED for STEMI and 100% of those patients have received their thrombolytics within 30 minutes.

Contact: Trey Dobson, MD, CMO