1. High Level Process Mapping

2. 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.