High Level Process Mapping

Sample Flowchart Lytics order written ECG tracing done by X within 25 mins Patient arrives in ED walking with complaint chest pain Change Question: Does triage occur Sample Flowchart before registration with all chest pains? Call made to internist as per long standing protocol to discuss whether patient should receive thrombolytic 5-30 mins ECG read by ED physician within 10-30 mins Do standing preprinted order sets exist and are they monitored for use? Who does the ECG tracing and is the resource available in dept? Is ECG clock checked daily and adjusted to match clocks in dept? Lytics administered to patient about 40 to 85 minutes post ECG What would need to change to facilitate expedited readings of ECG tracings ? What would it take to reexamine this long standing practice and introduce new practice? CME to increase ED physician confidence and competence in use of lytics ? MAC discussion? Internist discussion? Will change ideas tested to improve process increase the reliability of patients receiving lytics within 30 minute expected evidence based standard.