Belmond Medical Center Success Story

Belmond Medical Center had an opportunity to improve the care of patients presenting to our ER. One of the most important things we do, as a CAH facility, is triage and transfer patients to provide them with the best outcome. As a result, we are focus-centered on how we can improve the transfer time for patients experiencing chest pain, namely improving the time to diagnosis by reducing the time between arrival and EKG.

With a goal of 10 minutes from entry into the system for an EKG, our door to EKG times for the proceeding months were evaluated. The average times for the past several months were respectively 17.8, 16.9, 19.9, 33.5, and 22.7 minutes. With this information in hand, the objective was to create a program for the nursing staff and allow providers to gain an awareness of our present door to EKG time and reinforce the need for obtaining rapid EKG's.

The "Door to EKG" program consisted of:

• A presentation and discussion for nurses and providers including:
  • Education – statistical information related to cardiac events, and the "Time is Muscle" concept
  • BMC time statistics for the past several months
  • Ways to initially reduce the time
  • A commitment from staff for the need to make this a top priority
  • Setting next steps
• Development of a team to discuss physical and environmental barriers to success (including a provider and a nurse representative from each shift)
• A commitment to monitor progress and provision of routine progress reports

The presentation was initially met with some disbelief of the door to EKG times. This realization and awareness of the effects was truly the key to change. The reinforcement of the cause and effect was important for staff. Nurses immediately began to focus on the early EKG in association with aspirin and oxygen as the basics. Other early changes were associated with physical placement of the EKG machine and staff training. During off hours, when nursing did not have the services of lab readily available to perform the EKG's, the EKG machine was moved into the ER where it was available. Training was provided to nursing staff so all were able to perform EKG's in the absence of help from the lab.

As per the commitment, reports were provided at nurses' meetings on a monthly basis in two variations. One variation showed each individual EKG time and the other demonstrated the Suzan Brunes average EKG time for the month. This information enabled us to analyze any particular outliers.

Although we have very few EKG's on a monthly basis, we have demonstrated follow through on our commitment to reduce our door to EKG time so that, "100% of people will have the potential for less heart damage every year" as they come through our Emergency Department. Since the December presentation, changes have been made, training completed and our Door to EKG time has been below 10 minutes each month.

Belmond Project Data Sheet



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