1. Peck, Mechelle BSN, RN, RCIS, Faculty Advisor
  2. Fulton, Janet S. PhD, RN

Article Content


The purpose of this project is to demonstrate improved patient outcomes from a multidisciplinary team approach and the importance of clinical nurse specialist participation in developing team-based protocols for care.



Multihospital systems can improve door to balloon time in emergency catheterization patients. One key to success is having a nurse-initiated cardiac emergency response protocol that functions as part of a larger multidisciplinary approach to care for this selected patient population.



To improve patient outcomes, the American College of Cardiology/American Heart Association recommends door to balloon time of 90 minutes or less for patients requiring emergency cardiac catheterization. Nurses are often the first responder to a cardiac event; therefore, nurses need to participate in the creation and evaluation of protocols and system changes to help assure that necessary interventions are prompt and efficient.



St Francis Hospital is a 3-campus hospital system with a Heart Center where all cardiac catheterizations are performed. A multidisciplinary team was convened consisting of a cardiologist, emergency department physician, cardiac catheterization laboratory manager, coronary intensive care unit manager, cardiac quality manager, pharmacist, emergency department nurse, telecommunications representative, and clinical nurse specialist student. This team assessed overall patient needs and system resources and build a cardiac emergency response team that would function at all 3 campuses to provide evidence-based care for patients in need of emergent cardiac catheterization.



Door to balloon times improved from an average of 113 to 75 minutes-a 38-minute (34%) decrease in treatment time with increased average patient cardiac output (ejection fraction). In addition, length of stay for emergent catheterization patients was decreased by 2 days. Other outcomes included improved communication and coordination of care among involved providers and between hospital units. An ongoing audit procedure provides opportunities for continuing improvement.



Clinical nurse specialist student participation in a creating a multidisciplinary emergency cardiac team was a positive experience. The clinical nurse specialist student helped to demonstrate the critical contributions nurses make to improved care of patients with emergent cardiac problems.


Implications for Practice:

A team approach should be used to address complex problems that involve multiple disciplines across several settings.