Abstract 16098: Optimizing Door-to-Balloon Time in STEMI: Implementing a Failure Mode and Effects Analysis
Background: Prompt PCI for patients with STEMI significantly reduces morbidity and mortality and is now standard of care. ACCF/AHA/SCAI guidelines recommend achieving door-to-balloon (D2B) time within 90 minutes. Our quaternary care university hospital did not consistently meet D2B goals. We sought to identify the highest impact failures in our D2B process using a Failure Mode and Effects Analysis (FMEA). To our knowledge, this is the first application of FMEA to evaluate D2B in patients who present with STEMI.
Methods: An FMEA is a tool to prospectively identify and analyze potential failures that may lead to suboptimal results in a complex process. A multidisciplinary team, comprised of 17 members divided into two groups representing Emergency Medicine (EM) and Interventional Cardiology (IC), was assembled. After generating a chronological process map of the D2B process, each group identified potential points of error referred to as “failure modes” (FMs). FMs were then scored individually with regard to: a) likelihood of occurrence (O), b) severity (S), and c) likelihood of detection (D). Risk priority numbers were generated (RPN = O x S x D) to quantify the FMs of greatest impact. Each group then separately reviewed and re-scored, by consensus, the 11 FMs with the highest RPNs.
Results: The highest scoring FMs by the EM group were: delay in second ECG when initial ECG did not reflect a STEMI (RPN = 72); ECG misinterpretation (70); and unavailability of EM attending to review an ECG (48). The IC group identified the following highest scoring FMs: inability of patient to lie flat for catheterization (72); uncertainty of time elapsed with respect to D2B (60); transport delay to catheterization lab (60); and patient arriving in the lab clothed (60).
Conclusions: Using FMEA, multiple FMs in our complex D2B process were identified, some of which were unexpected. These FMs represent targets for future quality improvement initiatives designed to improve D2B at our quaternary care university hospital. Our multidisciplinary, systematic approach to process improvement using FMEA methodology may be a useful example to other institutions who aim to improve outcomes for STEMI care. We plan to implement improvement initiatives to eliminate or reduce the FMs with the highest RPNs.
- © 2012 by American Heart Association, Inc.