When Every Minute Counts, Even Minor Details Matter to Patient Care

Kim Miyauchi, Chief Nursing Officer 
Kingman Regional Medical Center, AZ

Saving the lives of heart attack patients is one of the biggest challenges for hospitals. When every minute counts, we all need to be looking at the same clock…that is one of the key messages our hospital learned when we examined mortality rates of patients with acute myocardial infarction (AMI). 

Kingman Regional Medical Center (KRMC) discovered that sometimes the simplest solutions can be the keys to saving lives. As part of the Leadership Saves Lives program, KRMC partnered with the Yale Global Health Leadership Institute and we were challenged to examine our hospital culture and treatment methods for patients with AMIs. We were part of 10 U.S. hospitals involved in the two-year program to determine causes of high AMI mortality rates. 

To reduce the AMI mortality rate at KRMC, we examined several possible determinants and honed in on three: 1) timeliness of EKGS; 2) protocols, pathways and guidelines; and 3) discharge process. We first addressed the causes by encouraging more teamwork. We created committees to examine each of the three causes contributing to our high AMI mortality rate. As teams engaged with each other and with other hospital staff they were better able to understand how and why goals weren’t being met and how to improve the results. 

For example, a large number KRMC patients arrive at the hospital by private vehicle — delaying the electrocardiogram (EKG) process that normally would take place in an emergency vehicle. Kingman Regional Medical Center strives to complete EKGs within 10 minutes of an AMI patient’s arrival. However, when we reviewed patient charts, we discovered our EKG completion times were inconsistent and recorded times depended on which clock a staff member was using. We had eight clocks in the ER and they were not synchronized. This had to be addressed to improve patient care.

Our hospital replaced all of the ER clocks and synchronized them with our computer system. This simple, inexpensive solution, along with its other efforts ended up significantly improving timeliness of care. Although all of KRMC’s process changes were not as simple as replacing clocks, we have already seen the efforts paying off with a decrease in AMI mortality rates.