The Clinical Nurse Leader as Outcomes Manager in the Emergency Department: Improving Door-to-ECG Time for Patients Presenting with Chest Pain

<p>A clinical nurse leader can develop a culture of quality in the emergency department (ED) through leading process redesign, workflow, and team engagement. The American Heart Association guidelines recommend that a 12-lead electrocardiogram (ECG) be performed and interpreted within 10 minutes of ED arrival on all patients with symptoms suggestive of ST-segment elevation myocardial infarction (STEMI). A local community hospital was not meeting this benchmark for walk-in patients presenting with chest pain or chest discomfort. Based on Lewin’s theory of change and utilizing the Institute for Healthcare Improvement’s model for improvement, a change package of practical interventions was developed and implemented to achieve improved outcomes. The primary intervention involved creating a chief complaint-based ECG guideline algorithm that streamlines the evaluation of potential cardiac patients. A secondary intervention involved designating a specific room within close proximity of the initial triage area for performing 12-lead ECGs. Methods included a microsystem assessment, literature review, team formation, rapid cycle testing, and ongoing data analysis. Results indicate a change from baseline of 64% to 88% over twelve weeks. This paper describes the process improvements and culture change required for optimizing clinical and operational outcomes in the ED.</p>

Name thesis:degree_name

Master of Science in Nursing (MSN)

Level thesis:degree_level

Restricted Project/Capstone - USF access only

Year dc:date.available

2017

Author dc:creator

• Estabillo, Arbie

Contributors dc:contributor

• Dr. Mary Seed

• clinical nurse leader
• emergency department
• quality improvement
• door-to-ECG
• STEMI
• outcomes
• Critical Care Nursing
• Medicine and Health Sciences
• Nursing

Repository record dc:identifier

https://repository.usfca.edu/capstone/596

OAI identifier oai:identifier

oai:repository.usfca.edu:capstone-1621