The effect of failure mode and effect analysis on reducing percutaneous coronary intervention hospital door-to-balloon time and mortality in ST segment elevation myocardial infarction

Kuo, Feng Yu; Huang, Wei; Chiou, Kuan Rau; Mar, Guang Yuan; Cheng, Chin Chang; Chung, Chen Chi; Tsai, Han Lin; Jiang, Chen Hung; Wann, Shue Ren; Lin, Szu‐Ting; Liu, Chun Peng

doi:10.1136/bmjqs-2012-001288

Cited by 12 publications

(6 citation statements)

References 31 publications

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“…On the other hand, only 20–30 percent of patients with cardiac ischemic symptoms achieved the target time of DTE within 10 min 8 , 12 so that several quality improvement programs had been proposed for shortening the DTE time. Among them, triage ECG, which is the acquisition of ECG during triage before history-taking by emergency physicians, is widely implemented in the ED setting 4 , 10 , 13 – 15 . However, the downside of triage ECG is that, in addition to the need for setting up ECG equipment, technicians and space in the triage area, indiscriminate ECG for patients with suspected STEMI is not cost-effective and can be time-consuming so that the care for other patients could be delayed 16 .…”

Section: Introductionmentioning

confidence: 99%

A modified cardiac triage strategy reduces door to ECG time in patients with ST elevation myocardial infarction

Tsai

Hsu

et al. 2021

Sci Rep

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Timely performing electrocardiography (ECG) is crucial for early detection of ST-elevation myocardial infarction (STEMI). For shortening door-to-ECG time, a chief complaint-based “cardiac triage” protocol comprising (1) raising alert among medical staff with bedside triage tags, and (2) immediate bedside ECG after focused history-taking was implemented at the emergency department (ED) in a single tertiary referral center. All patients diagnosed with STEMI visiting the ED between November 2017 and January 2020 were retrospectively reviewed to investigate the effectiveness of strategy before and after implantation. Analysis of a total of 117 ED patients with STEMI (pre-intervention group, n = 57; post-intervention group, n = 60) showed significant overall improvements in median door-to-ECG time from 5 to 4 min (p = 0.02), achievement rate of door-to-ECG time < 10 min from 45 to 57% (p = 0.01), median door-to-balloon time from 81 to 70 min (p < 0.01). Significant trends of increase in achievement rates for door-to-ECG and door-to-balloon times (p = 0.032 and p = 0.002, respectively) was noted after strategy implementation. The incidences of door-to-ECG time > 10 min for those with initially underestimated disease severity (from 90 to 10%, p < 0.01) and walk-in (from 29.2 to 8.8%, p = 0.04) were both reduced. In conclusion, a chief complaint-based “cardiac triage” strategy successfully improved the quality of emergency care for STEMI patients through reducing delays in diagnosis and treatment.

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Section: Introductionmentioning

confidence: 99%

A modified cardiac triage strategy reduces door to ECG time in patients with ST elevation myocardial infarction

Tsai

Hsu

et al. 2021

Sci Rep

View full text Add to dashboard Cite

show abstract

“…On the other hand, only 20 to 30 percent of patients with cardiac ischemic symptoms achieved the target time of DTE within 10 minutes [8,12] so that several quality improvement programs had been proposed for shortening the DTE time. Among them, triage ECG, which is the acquisition of ECG during triage before history-taking by emergency physicians, is widely implemented in the ED setting [4,10,[13][14][15]. However, the downside of triage ECG is that, in addition to the need for setting up ECG equipment, technicians and space in the triage area, indiscriminate ECG for patients with suspected STEMI is not cost-effective and can be time-consuming so that the care for other patients could be delayed [16].…”

Section: Introductionmentioning

confidence: 99%

“…Primary percutaneous coronary intervention (PCI) is the gold-standard treatment for patients with STelevation myocardial infarction (STEMI) 1,2 .Timely coronary artery reperfusion after arriving at emergency department (ED) is important for reducing mortality and morbidity rates for patients with STEMI [3][4][5] . Doorto-Balloon Alliance has chosen key strategies for improving door-to-balloon (DTB) time, which included the activation of the catheterization laboratory with a single call by emergency physicians, completion of PCI team preparation within 20 to 30 minutes after the call, rapid data feedback, adoption of a teambased approach, and administrative support 6,7 .…”

Section: Introductionmentioning

confidence: 99%

A modified chief complaint-based cardiac triage strategy for reducing delays in the management of patients with ST-elevation myocardial infarction

Tsai

Hsu

et al. 2021

Preprint

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Timely performing electrocardiography (ECG) is crucial for early detection of ST-elevation myocardial infarction (STEMI). For shortening door-to-ECG time, a chief complaint-based “cardiac triage” protocol comprising (1) raising alert among medical staff with bedside triage tags, and (2) immediate bedside ECG after focused history-taking was implemented at the emergency department (ED) in a single tertiary referral center. All patients diagnosed with STEMI visiting the ED between November 2017 and January 2020 were retrospectively reviewed to investigate the effectiveness of strategy before and after implantation. Analysis of a total of 117 ED patients with STEMI (pre-intervention group, n = 57; post-intervention group, n = 60) showed significant overall improvements in median door-to-ECG time from 5 to 4 minutes (p = 0.02), achievement rate of door-to-ECG time < 10 minutes from 45–57% (p = 0.01), median door-to-balloon time from 81 to 70 minutes (p < 0.01). Significant trends of increase in achievement rates for door-to-ECG and door-to-balloon times (p = 0.01 and p = 0.006, respectively) was noticed after strategy implementation. The incidence of door-to-ECG time > 10 minutes for those with initially underestimated disease severity was also reduced from 90–10% (p < 0.01). In conclusion, a chief complaint-based “cardiac triage” strategy successfully improved the quality of emergency care for STEMI patients through reducing delays in diagnosis and treatment.

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“…8 Moreover, the Joint Commission on Accreditation of Healthcare Organization recommended that FMEA be conducted for risk assessment at least once a year. 9 Since then, many clinical departments in the hospital such as radiology, 10 cardiology, 11 dialysis unit, 12 and intensive care unit 8 have actively accepted FMEA as a critical quality improvement tool. For example, FMEA enabled Mercy Hospital Springfield to reduce the incidence of surgery site infections, resulting in a huge cost saving, shortened length of stay, and fewer readmissions.…”

Section: Introductionmentioning

confidence: 99%

“… 13 Likewise, FMEA reduced the median door-to-balloon time from 146 to 32 min in patients with ST-segment elevated myocardial infarction, which contributed to a lower risk of reinfarction and mortality. 11 …”

Section: Introductionmentioning

confidence: 99%

Failure mode and effects analysis drastically reduced potential risks in clinical trial conduct

Lee¹,

Lee²,

Baik³

et al. 2017

DDDT

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BackgroundFailure mode and effects analysis (FMEA) is a risk management tool to proactively identify and assess the causes and effects of potential failures in a system, thereby preventing them from happening. The objective of this study was to evaluate effectiveness of FMEA applied to an academic clinical trial center in a tertiary care setting.MethodsA multidisciplinary FMEA focus group at the Seoul National University Hospital Clinical Trials Center selected 6 core clinical trial processes, for which potential failure modes were identified and their risk priority number (RPN) was assessed. Remedial action plans for high-risk failure modes (RPN >160) were devised and a follow-up RPN scoring was conducted a year later.ResultsA total of 114 failure modes were identified with an RPN score ranging 3–378, which was mainly driven by the severity score. Fourteen failure modes were of high risk, 11 of which were addressed by remedial actions. Rescoring showed a dramatic improvement attributed to reduction in the occurrence and detection scores by >3 and >2 points, respectively.ConclusionsFMEA is a powerful tool to improve quality in clinical trials. The Seoul National University Hospital Clinical Trials Center is expanding its FMEA capability to other core clinical trial processes.

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The effect of failure mode and effect analysis on reducing percutaneous coronary intervention hospital door-to-balloon time and mortality in ST segment elevation myocardial infarction

Abstract: This study found that failure mode and effect analysis is a powerful method for identifying weaknesses in D2B processes and evaluating strategies to reduce the D2B time.

Cited by 12 publications

References 31 publications

A modified cardiac triage strategy reduces door to ECG time in patients with ST elevation myocardial infarction

A modified cardiac triage strategy reduces door to ECG time in patients with ST elevation myocardial infarction

A modified chief complaint-based cardiac triage strategy for reducing delays in the management of patients with ST-elevation myocardial infarction

Failure mode and effects analysis drastically reduced potential risks in clinical trial conduct

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