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IHI calls this type of work “Extending the Chain” – moving upstream in a process to
improve quality, safety and efficiency.
Attributes success to rapid ‘in-processing’ all patients from the metro or rural
• Developed system to process patients faster en route to hospital (ground and air)
• Reduced air transport flight time max to 30 minutes (for helicopter one way)
– TAT skids to skids at pick up point is 10 minutes (don’t shut the rotors off)
• Fully assessed 30 community and rural hospitals in network:
– helped them set up the program,
– spent a whole day in the ED to see their processes and
– helps them streamline everything to minimize time spent on processing patients
• No handoff verbal report
– Quick-use forms allow physicians to quickly verify all needed information
• Keep track of all AMI drugs used
– Abbott Compliance is high
– Debriefs each case with all hospitals
• Ambulance or flight teams identify smokers and the Cath Lab includes float wires during cath
• 16 slice CT remote when possible; OR team sets up based on readings shipped electronically
• Use STEMI reaction protocol in the ED
• Hardest to streamline is ordering blood;
– currently working to allow ordering 20 units with one simple order in computer