Providing data also helps with physician involvement because physicians respond well when presented with data supporting the change.
"You've got to allocate the resources for this. It's not something you can do with a limited number of resources," says Fore. "Not every quality department has the resources to do this; therefore, everyone in the hospital has to be engaged in core measures."
It also helps to have leadership on your side, firmly behind the tracking and improvement of core measures.
"Leadership definitely supports this," says Fore. "It is coming from the top down. Our CEO is very involved. Every single member of the executive team is familiar with core measure outcomes. It's very much a focus for RMC and [Hospital Corporation of America."
One core measure indicator that provided additional challenges during RMC's improvement efforts was door-to-balloon time. Door-to-balloon is an emergency cardiac care measurement of time for treatment of ST-segment elevation myocardial infarction (STEMI) and is a core quality measure of The Joint Commission.
The interval starts with the patient's arrival in the emergency department and ends when a balloon catheter crosses the culprit lesion in the cardiac cath lab. Delays in treating a myocardial infarction increase the likelihood and amount of cardiac muscle damage due to localized hypoxia. Guidelines recommend a door-to-balloon interval of no more than 90 minutes.
"Our door-to-balloon time was a challenge," says Stewart. "We've got a multidisciplinary team together to look at our STEMI patients."
"This was a multidiscipline improvement project, working with staff from EKG, cath lab, admissions, laboratory, and more," Fore says. "RMC dropped its door-to-balloon time from 120 minutes to 90 minutes, with more improvements on the way.
"Very soon it will be 60 minutes," she adds. "We've been under 90 minutes for the better part of a year. The way we will be able to meet that 60-minute target in our geographic area is to have a countywide STEMI program."
The ambulances and paramedics in the region, once they recognize symptoms of chest pain, are able to run an EKG and determine with good certainty what they are dealing with. This is transmitted to the closest facility, and the paramedics can start medications in the field.
"We know exactly what our goal is when the patient arrives—we're taking them right to the cath lab," says Fore.
There are eight STEMI-designated emergency rooms in the county, which had to prove they could provide patients with a door-to-balloon intervention in a window of under 90 minutes. RMC's emergency room is one of the eight.
"Our next challenge will be to add more diagnoses to core measures," says Fore.
RMC's next target will be in perinatal initiatives.