According to a recent Iowa Hospital Association “Quality Indicator Report” for the first quarter (Jan-Mar) of 2009.  If you have the misfortune of having a heart attack – Knoxville Hospital & Clinics provides immediate treatment and gets you to a hospital with a cardiac cath lab 36 minutes faster than our peer group and state of Iowa hospital averages.

According to Iowa Hospital Association “Quality Indicator” reporting for the first quarter of 2009 (see chart below), patients that presented to our emergency department are transferred to a hospital with a cardiac cath lab in 59 minutes – as compared with our peer group and state of Iowa averages of 95.61 minutes.

According to the American Heart Association, every year, 1.5 million Americans will have acute myocardial infarctions (heart attacks).  Of those, approximately 400,000 die.  A heart attack or Acute Myocardial infarction (MI) occurs when the blood vessels supplying the heart with oxygen, become clogged by blood clots or plaques.  Once the blood flow has been interrupted, the heart muscle begins to die.  If blood flow is not restored within a brief time frame, irreversible damage to the heart muscle will begin to occur, which frequently leads to death.

The goal of care at KH&C is to immediately treat patients showing signs and symptoms of heart attack and once diagnosed, to restore blood flow as soon as possible.  The primary intervention used to restore blood flow to these patients is cardiac catheterization, (balloon).

The federal government (CMS) implemented an industry-wide standard set of Core Measures developed to help improve outcomes for these patients. “Door-to-balloon” is a time measurement in emergency cardiac care (ECC), specifically in the treatment of ST segment elevation myocardial infarction (or STEMI).  The interval starts with the patient’s arrival in the emergency department, and ends when a catheter guidewire crosses the culprit lesion in the cardiac cath lab.

Because of the adage that “time is muscle”, meaning that delays in treating a myocardial infarction increase the likelihood and amount of cardiac muscle damage due to poor oxygenation of tissue, The American Heart Association guidelines recommend a door-to-balloon interval of no more than 90 minutes.

As a rural hospital, Knoxville Hospital & Clinic’s main goal is to start the initial interventions and get these patients to a higher level hospital like Mercy Hospital or IMMC in Des Moines where they can have the balloon procedure as soon as possible.

The core measures we can impact in the care of these patients are: 

• Administration of aspirin to everyone who does not have a contraindication within the first 24 hours of admission.
•  Administration of a 12 lead EKG as soon as possible upon arrival.
• Cardiac Catheterization (PCI) within 90 minutes of arrival

We are very proud of the work we have done in improving our process with Acute MI patients here in our Emergency Department as evidenced by Iowa Hospital Associations Quality Indicator Report (below) for 2009’s first Quarter:

• Average Aspirin administered at KH&C = 100% – Peer Group Average = 91.35% – State Average = 92.38%
• Average length of stay prior to 12 Lead EKG at KH&C = 10 minutes – Peer Group Average = 12.11 minutes – State Average = 11.73 minutes
• Average lenth of stay prior to transfer at KH&C = 59 minutes  – Peer Group Average = 95.61 minutes – State Average = 95.61 minutes

• Liked the new warm surgery gowns and slipper socks.
• (Pleasanville)  I appreciate the early morning hours.  The Pleasantville Clinic is a friendly, helpful place where I feel comfortable receiving my health care.
• I had appionment scheduled with Dr. McKeever and Elaine.  They were both so kind.  He scheduled an MRI and Bobi who did it was great.  All good.
• For a small hospital they are very organized and do a great job.  I saw Dr. Albrecht from Des Moines at Knoxville and am pleased with outpatient service.
• Dr. Busick is great!

One in five Americans has experienced a medical error according to a 2002 study by the Commonwealth Fund. Medication errors are one of the most common medical errors in hospitals. A 2005 report by the Agency for Healthcare Research and Quality reported only five percent of US hospitals were using barcode technology for improving patient safety with medication administration. KHC is one of 43 Iowa hospitals using a technology that helps ensure fewer medication errors happen in our facility. KHC uses a barcode system to make sure the right patient gets the right medication at the right time in the right dose and by the right route (a pill by mouth, an IV, or an injection). This technology enhances the safety of our patients and is a great example of the cooperation between our pharmacy and nursing staff. In the past six months over 40,000 doses of medications have been given to our inpatients. We monitor how often our safety check process is used. I’m proud to report the barcode technology was used to give over ninety percent of those 40,000 medications. Typical compliance rates with this technology are between seventy and eighty percent. Not only do we have this safety technology, but we use it, and we use it with a high degree of consistency. This commitment to medication safety is one way we demonstrate we are committed to successfully meeting the needs of those we serve.

Contributed by:  Christine Buttell, Chief of Patient Care Services

GOAL:  We will achieve demonstrated improvement in quality throughout our organization
MEASUREMENT:  We will be at the level of “Top Hospitals” in the CMS hospital and physician quality indicators

OBJECTIVES

• Insure that we have processes in place so that our staff can provide exceptional quality care
• Insure that we have a facility that enables us to provide exceptional quality care
• Benchmark our performance against best performers