Metrowest Medical Center is one of the top performing Vanguard hospitals in the Chest Pain Initiative due to their multidisciplinary teams commitment. Metrowest Medical Center has participated in the AMC Registry Inc. Chest Pain Initiative since July 2005 with the goal of improving the care of all patients who present to the Emergency Department with chest pain. Initial data was collected from Quarter 2 2005 and entered into the database to determine our rate of compliance with 7 process improvement initiatives which include:

• EKG within 5 minutes of arrival to the ED
• Time to reperfusion with PCI within 90 minutes
• Heparin usage in patients receiving reperfusion therapy
• ASA administration on arrival for chest pain patients (not contraindicated)
• Documentation of ECG readings
• Concordance rate between ED physician and official reader on initial ED ECG
• Reperfusion therapy or documentation of exclusion criteria in STEMI patients

Metrowest Medical Center completes a monthly retrospective chart review with data abstraction entered into the AMC Registry Inc Database. Monthly reports are compiled from the database with review of the data. Process Owners for each of the above indicators were assigned and are responsible for the continual review of the variances for their indicator on a monthly basis. A Chest Pain Committee was formed which includes the Chief Medical Officer as Chair, CNO, physician and nursing leadership from both Emergency Departments, Cardiologists and ICU/CCU nursing management from both campuses, Cath Lab and Quality Management epresentatives. The Process Owners provide a variance summary report and improvement initiatives monthly at the Chest Pain Committee Meetings. Through the team approach, Metrowest Medical Center has been able to make significant improvement in the Composite Goal Percentage (CGP), the average of all seven initiatives, since the initial results for Q2 2005 of 67%. The CGP has gradually improved through the hard work and accountability of the process owners, Chest Pain Committee members, and administration to the latest CGP for Quarter 2 2006 of 79%. Metrowest Medical Center is committed to providing the best care for all of our chest pain patients.

Beth Garofalo

Chest Pain Initiative Coordinator