please review the case on page 507, chapter 7- Door to Balloon( percutaneous Coronary Intervention(PCI) and answer questions 1-7 at the end of the case

120-msinute Doot to Ralloon (PC1), and 68s Part 0 me (ED) admission to FCl was 120 minule bat the: (ainiere perfoemed a retrospective revieve of revised target is now $0 minutes or less. siest irom paticnts with signs and symptoms fofst itads. Data were collected from Imerpripepartincot records and Cardiac CatheFiai(athtab) ener the past year these data The data wete analyeed to-determine potential i war ditemined that 32% of cases exceded root causes of delays to PCI. Chapter in Henth Cape Manauementur. HGURe 105 FiGuat 1s : Number of Patients (Cases) Afmitted to the PCI in over 90 Mnutes by Duy olWent Potential factors that did not appear to be driving Door to PCI time over 90 minutes included: Time to First ED EKG, 86% were 5min - Potential factors that indicated pesct: utes or less. - Start of PCI procedure to "crossing the Hour of the Day lesion" (which is when myocardial infarc- Most delays to PCI were betweed br tion blockage is at least partially relieved). hours of 6:00a.m, to 4:00pm. she Wrek: available mere camies of sigeificant aletays. (8oss ecrlainty). n Invesiverinacrwonional Candideigas of secondary comsulfant: , part Three Invavelinerventional Cardicdergat as Frimary Cansultanti Mran 109 minvates. Stasdard Lleviation 29 (ibe anitil data analyaiss the Quality. Interwentionalist as Secoedary Cron Coutsinitece arranged to have: a milente Mran 123 minutes 5 tandard Department (ID) and Cath Lab Deviation 74. ED phisicians explained that the linerviews with fepreuentatiyes of the cundeon-all criteria were developed ology plysician groupe revealed that maintainit atven of PCI. The on call schedule ing an on call schedule of the ED had bevome 6) both nort-invaseve cardiologists and gists wing dithicul due to the lack of cantekeie intrientional cardiologhts. There- gists willing to take frequent BD an-call. paients ado were candidates for PCI The Quality Management Commitse Whe the pon-invasive cardiologists to refer assembled a meeting inchuding the Chief NurtBare an indaweinterventional cardiol ing. Officer, Medical Ditectoe of Cardicingy. as bic secondary consultant. This could and representatives from the hospitals CardiFolinddelaytostartthePClprocedure.fortheranalysisindicatedthatatleastaologyphysiciangrougs.Thismoetingwastheformationofthe"EDtoPCITaskForce. Sat portion of delays appeared to be ar tie need for an invaciverinterventional Discussion 0uestions Itwitgit to be consalied and perform the: puluec. Charts were reviewed for "primary 1. What are other the stakeholders that ternatians admiteted through ED; sec could be incloded in this Task: Force? 1int th. Findings conctuded that cases 2. What further information would be help* 4 thr iaravelinterventional cardiologists ful to further clanify the root caise(s)? iv misel coosultants and not iramediately. Provide rationale fot your sugestions. 510 Chapter 18 Health Care Management Case Stuilies and Cuidelines 3. What might be the incentives and dis. incentives for taking ED on-call? 4. List possible changes to the on-call schedule that might improve the aval. ability of the invasiverinterventional. cardiologists. 5. What should be considered if there were not enough invasiver interventional cardiologer woting 6. What might be sloint ferim of prior to lo longer termat iedoenpos 7. Does the Cath Lalis capes