3 Guiding Questions to Help You Reduce STEMI Process Variability [Part 2]

EDITOR'S NOTE: Special thanks to Shane Elmore for writing today's blog post. Shane served as Pulsara's Vice President for Clinical Innovation and Development from 2013-2022. You can connect with him on LinkedIn. 

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In last week's blog post, I talked about the root of all evil in STEMI care processes: VARIABILITY. 

There are several areas where we commonly see variability in STEMI processes. Here are 3 questions whose answers will give you some insight into whether you might have a variability problem at your facility: 

STEMI care is stressful. But it doesn't have to be.

1. Do you use EMS ECG transmission?

ECG transmission is a good thing in most cases. It's a superb idea if you're using it as a confirmation of STEMI. If you are using it because your ED and Cardiologist don't trust EMS, however, it will only slow you down. Variability comes in when you ask EMS to transmit the ECG sometimes, but not others. The answers I hear most of the time when I ask if a hospital uses EMS ECG transmission are some variation of:

• "Well, most of the time we do."
• "We have a 20% transmission rate."
• "Not all EMS agencies have the capability." (Ouch...do they know that Pulsara is 100% free to EMS? And that they can instantly and securely transmit the ECG to you using equipment they already carry around with them?)

If these answers sound familiar to you, then you likely have a variability problem. 

2. Do your Cardiologists ask to see an ECG before they come in?

• "Some do, it just depends on who's on call."
• "Sometimes we take a picture and text it to the cardiologist."

These answers tell me that you provide a higher level of care to some patients but not all. This is very common but entirely unacceptable in my opinion. You would be better off not sending pictures at all and trusting your ED physician to make the call. Nevermind the fact that you're texting PHI ... that is a different blog post all together.  

3. Who delivers the patient to the cath lab?

• "It depends on who's on call."
• "Sometimes the ED does it, and other times the Cath Lab comes down."

This variability can create a situation where the Cath Lab is ready, and the ED doesn't know it. The Cath Lab is waiting for the ED to bring the patient up, and the ED is waiting for the Cath Lab to come and get them ... 20 minutes and lots of heart tissue later, they finally contact one another.

People also say "We just call." That too, of course, takes too much time. Phone calls are a huge waste of time when they're compensating for a poorly controlled process.

So what are the areas where variability is hindering your patient care and outcomes? Probably you don't even think about these situations as being detrimental. But a little time here, and a little time there really adds up and can mean the difference between a fast and full recovery, and a nursing home for your patient. 

Do everyone a favor and take a hard look at your processes - and if you still need help straightening these things out, Pulsara is here to help.