Electrocardiogram is known as EKG and it involves heart tests done with regard to establish its electoral activity. These tests are for purposes of knowing the heart’s performance. Door-to-EKG time variable for any institution that seeks to demonstrate the quality of result on the patient is a partly measure of commitment to improve care. The extent of Checks and balances in the Door-to-EKG time is a realization of the need to further scale down time from the onset when the patient arrives to the facility until the patient is discharged from the facility. However, on a relatively narrow perspective this is restricted to the span between patient arrival and admission into the EKG room. In order to realize the positive outcomes of reducing Door-to-EKG time is subject to a rigorous approach to revisiting the patient care cycle from entry to exit. This should be an ongoing process rather than an occasional audit event thus a proactive approach aimed at the reducing time (Hanys Institute of Quality, 2009). How proactive towards time reduction problem will depend on the active anticipation among the practitioners in response to patient needs and the in-house time restriction benchmarks that have been set. In addition, relative to other factors need to be measured based on the degree of patient satisfaction and revenue generated. Inefficient service systems will have adverse impact on the two. Efficient systems withstand pressure effectively during peak activity periods. The bid to achieve this, translates to a continuous screening and setting time benchmarks of the service delivery protocols and honoring the fact that continuous improvement as a strategy to achieve the goal (Answers.com, 2010). Arguably, the facility landscape may impede on the time factor but to a lower scale. Nevertheless, this will depend on the relative position of the EKG room within the facility infrastructure. This is an aftermath of the initial architectural planning of the facility. It is imperative to limit the Door-to-EKG time window. Through a report, KnowWare International Inc, (2010, p.4) recognize Door-to-EKG time window as among the pertinent issues within health facilities and put forwards measures for countering. Northwest Community Hospital (n.d., p.26) in their profiles of nursing excellence 2009 pegs a ten minutes window for the Door-to-EKG time. According to Hanys Institute of Quality, (n.d., p.18) Rochester General Hospital in Rochester applies the lean six-sigma strategy to improve their patient service delivery. Lean six-sigma strategy has potential failure and effective analysis (FMEA) as well as “Plan-Do-Check-Act” cycle. Lean six-sigma is an active anticipation to problems through prediction and attempting to solve them before they take place. According to Dovich (n.d.), an FMEA present a methodical strategy of determining the questions: “How can a process or product fail? What will be the adverse systemic effects in the wake of failure? What constitutes the preventive mechanisms to avert failure? The design and process matrices come in handy in tackling of these questions (Relex Software Corporation., 2008, p.2). According to the article by Lee, et al. (1999, p.1), Statistician Walter Shewart from United States coined a four phase conceptual framework (Plan-Do-Check-Act systematic procedure) for rooting out a problem. In this cycle, each phase has a list of requirements to fulfill before moving to the next stage. Lee, et al. (1999, p.1) explains that Edwards Deming furthered the idea in the famous ‘the Deming Wheel’ in the 1950s. The cycle can be utility tool in planning where actions are to be pragmatic and consistently sensitive to the plan. Such planning should allow proceeding while posting improvement results. Also useful at team building level to gauge improvement for solutions adopted and provide avenue to weigh among alternatives the most viable. Complete implementation of the cycle on repeated occasions for all the problems deemed to provide continuous improvement for operations. KnowWare International Inc, (2010, p.4) explains the time value-addition of their reducing Door-to-EKG time window to physician within the ED at Umass Memorial Health Care. As a mark of success, the lessons learnt aided in replicating the strategy elsewhere in the facility. Northwest Community Hospital (n.d, p.26) recognize door-to-EKG among the variables in the patient care systems for setting their benchmarks for accreditation.
Validation and Literature Review
The functioning of the human heart is a process that exhibits and that relies on electrical activity. According to the article “What is an Electrocardiogram?” an electrocardiogram or EKG is a test that records this electrical activity (2008, p.1). The electrical activity being talked about here is in the form of electrical signals that are fundamentally instrumental in the functioning of the heart. As the article further points out that an electrical signal is relayed from the heart’s top to its bottom with each single heartbeat (2008, p.1). This relay of signals from the top to the bottom of the heart causes a contracting effect on the heart that enables it to pump blood to the rest of the body. This particular relay of electrical signals will happen every single time the heart beats. The electrical signals are responsible for setting a rhythm for the heartbeat that can be listened to using a stethoscope. An EKG test according to the article above will show; how fast the heartbeats are, whether the heartbeats rhythm is steady or irregular as well as the strength and timing of electrical signals as they travel through each part of the heart (2008, p.4).
An EKG test is designed to be simple and painless and it can detect as well as evaluate a number of heart complications or disorders. Some of these complications that can be detected and evaluated by the EKG test as provided by the above article include; heart attacks, heart failures and arrhythmia (2008, p.5). Additionally, EKG tests carried out on a person can be used to monitor the working of the person’s heart.
One measurement of time at the centre of emergency cardiac care (ECC) in hospitals is the door-to-balloon time measurement. According to the article “Door-to-balloon” it is especially more pronounced in the treatment of St segment elevation myocardial function, which is also known as STEMI (2010, p.1). The article goes on to state that, the time measurement is started when a patient arrives at the emergency department and stopped when a catheter guide wire crosses the culprit lesion in the cardiac lab (2010, p.1).
According to KnowWare International Inc., the Umass Memorial Health Care has an improved door-to-balloon value of less than 60 minutes (2010, p.4). Improved because there door-to-balloon value in 2004 was 180 minutes however in an aim to optimize door-to-balloon times they devised a four-step plan that brought about the fall in door-to-balloon value. The first step of this action plan addressed Door– to- EKG times and this fell to 1-2 minutes causing an improvement in physician efficiency (KnowWare International Inc., 2010, p.4). To reduce door-to EKG times an ambulance would transmit electronic EKG transmissions form a patient to the Emergency Department (ED) of the hospital. At the ED, the transmissions are processed and arrangements made in time to eliminate the need of the patient stopping at the ED. The patient therefore bypasses the ED and proceeds directly to the catheterization lab. This innovative way of handling such patients reduced the hospital’s door-to-balloon times to a value less than 50 minutes and the AMI mortality rate (KnowWare International Inc., 2010, p.4). The AMI mortality rate is a measure that is used to assess the number of deaths caused by acute myocardial infarction (AMI) out of 100 discharges (National Quality Measures Clearinghouse. 2010, p.11).
According to the article “Introduction to Baldrige Award Recipients”, the Malcom Baldrige National Quality Award is awarded to organizations based on achievement and improvements made in the all the seven categories specified by the Baldrige Criteria for Performance Excellence (2010, p.1). In the year 2005, the award was won by the Robert Wood Johnson Hospital. The hospital has Emergency Department turnaround times of 38 minutes for patients who will be discharged and 90 minutes for patients who will be admitted. KnowWare International Inc. in its report implies that this Emergency Department turnaround times are impressive considering that in 2009, Pres Ganey’s findings averaged Emergency Department turnaround times at over four hours (2010, 2). The hospital achieved this turnaround times through integrating an anti delay system in its operations. This kills delays before there conception creating smaller values of door-to-EKG and door-to-balloon. The system brought about greater customer satisfaction and pioneered the hospital’s growth rate of over 10% per year (KnowWare International Inc., 2010, p.2).
Northwest Community Hospital is a community hospital that has received accreditation twice from the Society of Chest Pain Centers as a Chest Pain Center; this follows its special commitment to take care of patients suffering from chest pains (Northwest Community Hospital, 2009, p.28). The hospital believes that to maintain such an accreditation it has to demonstrate quality health care at all times (Northwest Community Hospital, 2009, p.28). It plans to do this by undertaking to implement specific quality measures. Among the quality measures the hospital has in mind includes a door –to-EKG time of less than 10 minutes (Northwest Community Hospital, 2009, p.28). This underlines the importance of reduced door –to-EKG times in improving patient care.
AN EKG machine is one of the most basic diagnostic tools in emergency cardiac care, it is detects and records the hearts electric activity through its electrodes that are placed intentionally and strategically in certain parts of the body by following guidelines in a lead placement guide (MedSupplyGuide, 2008, p.1). The machine is operated by an EKG or ECG technician. In order to reduce door-to-EKG times it is important that an institution keep a properly working and improved EKG machines. It is thus important that the institution identify reliable suppliers that can supply EKG machines. A list of known credible EKG suppliers as given by TheMedSupplyGuide include Burdick, Philips Medical Systems and Cardioline Inc. (2008, p.8 – 14)
An EKG technician according to Bright Hub Inc. is someone who is trained in performing electrocardiograms and working with EKG machines (2010, p.1). EKG technicians need not be degree holders as is the case in most medical professions but need to have proper qualification credentials and demonstrate an ability to interact well with patients at all times. According to the nature of the job, an EKG technician is among the first hospital personnel with whom patients with chest pains or cardiac problems interact. An EKG technician is a must-have in the patient care team. The technician responsibilities are; preparing rooms where the EKG tests are conducted , ensuring that the EKG machine is set up and functioning properly, carrying out the EKG tests in an ethical manner, that is, following the right procedures and maintaining high standards of cleanliness in the EKG room. Nowadays ambulances are fitted with EKG machines; these helps to carry out EKG tests on a patient as soon as possible, the results are then transmitted to the hospital and the necessary logistics put in place to administer treatment to the patient immediately. So it is recommendable that in consideration with the hospitals capital, to seek the services of more than one EKG technicians such that they are available in ambulance pick-ups (MedSupplyGuide, 2008).
Comparative Evaluation
Reducing door-to-EKG times is known to make faster emergency departments. A fast emergency department means that patients do not have to wait for long periods before receiving services. This, as supported by KnowWare International Inc. in its report Get a Faster Hospital in Five Days, increases customer satisfaction which in turn means increased revenues for the hospital (2010, p.2). Therefore, reducing door-to-EKG times means that the hospital does not run the risk of unsatisfied customers.
The resources needed to reduce door-to-EKG times are machine, human and in some cases infrastructural. Human resources required includes a properly qualified EKG technician who is outgoing and can interact well with patients. Machine resources required includes an EKG machine that is properly functioning. Ambulances fitted with EKG machines are also another machine resource that is instrumental in reducing door-to-EKG times. Infrastructural investments include a designated room suitable for conducting EKG tests. It can also include an improved hospital design that enables easy and faster access of the EKG room.
In reducing door-to-EKG times, it is important that a hospital and in particular its emergency department maintains a state or readiness. Readiness is achievable and maintainable through continuous professional development (CPD), investment in latest technology and better hospital design. Continuous professional development according to Ndege is the process through which a medical institution maintains and promotes high standards of medical practice and care (2006, p.42). CPD boosts professionalism though offering extra training aimed at improving personnel ethics. Better ethics mean that each member of the hospital personnel possesses better decision-making and problem solving skills. Investment in the latest technology helps a hospital or cardiac clinic secure machinery that can improve the organization’s response to EKG related cases. The investments can be in EKG machines. The organization can opt for a particular EKG machine because it is portable, it presents findings in a better format, its computer program is easy-to-use or it has a capability to transmit EKG findings from a remote location. Better hospital design can improve communication and response times. Such a design seeks to reduce the distance a doctor or nurse covers in order to attend to a patient or to get information.
A current practice in hospitals in reducing door-to-EKG times is the use of ambulances fitted with EKG machines. EKG transmissions are transmitted from the ambulance to the emergency department where they are processed and action steps taken that enable patients to bypass the emergency department upon arrival to the hospital. Another current practice in hospitals in reducing door-to-EKG times is the demand that hospital staff keep records on their Continuous Professional Development plan. This is a measure undertaken to maintain high levels of professionalism and ethics in provision of health care.
Decision Stage
Decision-making that affect systems are tailor made to factor concerns of all wings of the management of the facility. This will draw representation in two ways: Administrative representation and Medical Practitioners within the facility. Often or not, co-opt on need basis outsiders. Professional consultants are outsourced as well. Administrative representatives provide solutions on personnel, legal and financial matters. Practitioners tackle mainstream medical matters. The generic of the decision determines who and when to co-opt in the process. Furthermore, on the theoretical approach to decision-making, that is either top-down or bottom-up. It is imperative to avoid bureaucracy and red tape ideals in the decision-making process. However, clear-cut frameworks will help to know how decision-making cascades down the facility’s management arms (University of Florida Health System, n.d.). Thus, overlaps and duplication of decisions are averted thereof. How decisions made will avert conflicts is a key indicator of the inherent strengths of the decision-making mechanisms in place. Decision-making should far much co-opt representatives directly affected by the outcome and factor in their concerns accordingly.EKG medical matters may need very little administrative decision attentions. While record keeping and archiving, staff recruitment, housekeeping schedules and financial accounting may call to the attention of the administration department. Medical practitioners co-opted from the different care areas will cut-across emergency department, critical care, cardiac surveillance, the cardiac catheterization lab, and case management. It will also factor in physicians, lab technicians, machine maintainers, pharmacists, nursing leadership, triage nurses, bedside nurses, theater nurses, EKG technicians and advanced practice nurses (Service Staff Inc, 2010, 12). Decision-making sessions can form basis for brainstorming for solutions on how to enhance operations. Experts in their different specialties bring onboard solutions at the decision-making table. Physicians recommend the medical treatment aspects. Nurses ensure care-giving operations are in order (The University of Florida Health System, 12). Patient transporters ensure patient delivery mechanisms are timely and efficient. Surgery technicians are versed equipment and instruments in theater rooms. Emergency Department staffs are on standby to provide rapid response to emergency cases. They align their operations with other department to ensure patient with emergency attention get immediate attention once at the facility. EKG technicians specialize on instruments and equipments in the EKG room. Sterile processing technicians avail timely fresh medical equipment supplies on sites they are needed. Health supervisors and managers organize their staff accordingly and ensure daily routines are undertaken. Food service staffs attend meals and dietary concerns especially of in-patients.
Decision made should foster efficiency through patient satisfaction; avoid imaging, lab and bed management delays; on time patient discharge; efficient revenue collection; accelerated patient attention and avert emergency department divert hours. Quality services delivery tie with on to timelines thus decisions made should factor that. Satisfaction is mark of quality this will reflect positively in the patient turnover and revenue collected (National Heart Blood and Lung Institute, 2008). Emergency cases will need special facilitation thus keen attention while making decisions. KnowWare International inc. (2010, 2) account that Robert Wood Johnson Hospital taster turnaround time led to growth by over 10%. No specific approach is recommendable to suit all decision-making needs in management systems but through continuous revisiting of the existing can get rid of unnecessary hurdles and replace with efficient ones (National Institute of Standards and Technology, 2010). Physicians, nurses and other staff can be motivated to seek accelerated approaches to service delivery. Encode this in their service charter for responsibility purposes. KnowWare International inc. (2010, 2) recommends that Emergency departments can cut the time spend in handling patients to between 35 to one hour. Reduced door-to-EKG time can enable physician more time diagnose and if need relay with surgical team. Properly maintained parking lot scales down time spent in parking. KnowWare International inc. (2010, 2) estimates that UMass Memorial Health at up to five minutes off.
Table 1. Proposed protocol guidelines
Plan for Evaluation
Table 2. Plan for Evaluation: Evaluation implemented after every three months
References
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