ࡱ> }|@= yٌ$)D3T&/]-iD'x}P6w?.I I1"?>Yz.(utLcccb6ףtυ2Wulj8PS1emm# f (7TGR?]GmGZX3OA*C.瓵ɔok7*V>ݝΞ=j_hi++־-Pڡ4/ (KN6J,b>ܿ۰3}aEun" A߷Q zyd}7 뛼. #~] {x0}C}dɒyaGg&7EBCo\lه^top%';i6)hMvJ_Ϳ^G׫.㗜KtB_Rh/sp%'/),xrXј6zZ7\ KN[ضhcpauLKη/^m>aض"KNe-ڷ\cEfx2]INIf;3~=j(!'" }6Kc^kL>C,?~я36F})/E~3g݌Qڼpc7s&Cu;rt *kc:F\BYb'lY1_EC60p }c ?TJ?f{A덯h]GƧ s0CÿŁ~+JѯIR]]\leswTy沨K7:1=֣ej}r }x[.ܐ`7TGs5wsY粩uˉณ@cߠqNc"\,v`iC/+cC,>ߺ")M.),#OMFZ]J8"67ntq ciq.-UhUƒxlAS+?ƭa6VN.֦KwOb_@icVۛ %q8[,O >!lzbb5~?/pcjZ¸V~zT5s&Rܘ3,{{sΙl2Qb>sMs&LUQk;U;i-o/˳c}/Mf\/Yi鈱ǩ0ln4,ɳUv\~ }\ɷ15m (KOMz0\d8״RoYB]|nmr n`pm4&ss'`_"=Z^ …o{A=>a;L|_vk׷>ej@|mpw}I0 {^״.Ut%n:DNXdr k/5],ū%FjeH^E^I^G"y"7"o!/MؾwIއP޻N5w"5yo'{"od$y߰LOk yX58ɋo蜍[;JoЗ^nm.sT׮j+ֈ;&}GW*Lk i˅ys`cx ۟ ct$wIxzg2bu G8(?\ ߽TZY%0B8`|á{T!M§%׽B|OSr]<K&IQz/&s(+eo=[Ӵ>XX#v?Ca>POq>Rl@%7oMC ִƘMzAtKoL9T\p d1 P>U^!V!BMultistep Care Process for D2B Complex and Multidisciplinary : Background Patient Flow Dynamics Tenet: Once delays occur, catch-up is very unlikely and additional delays tend to accumulate Cardiologists say:  Once we are behind in time, we have a tough time catching up! f!ZA7>W BackgroundED Tenet: Some ED patients with STEMI actually present initially with non-chest pain complaints (weakness, nausea), and this will delay time to EKG ED Tenet :  We don t have a bed to even assess this patient right now! :JJ  ObjectiveE To determine if D2EKG Delay ultimately led to D2B time > 90 minutesFF( MethodsIRB expedited approval; QI Study All Core Measure STEMI cases from 7/2006 through 6/2007 abstracted for key process times Primary PCI Academic Urban Medical CenterResults$  ConclusionsWe found no correlation between delay to EKG and D2B > 90 minutes. Other steps in the D2B process may have a greater influence on D2B time than D2EKG Delay to EKG in STEMI patients is not the singular determinant that would prevent D2B < 90 minutes  Conclusions>Interestingly, this same conclusion was made in Bradley; NEJM 355;22, 2317 The time to EKG was not a  significantly associated strategy that reduced D2B time$KT  Limitations6Small sample size Only Core Measure patients studied $7$/    ` i`` `(I{߶` ggg>?" dd@,?" Kd@ pd pA@pd`  n?" dd@   @@``PR    @ ` ` p>> xpL(  LT Uc% L "@ L BXCaDEF?`WW=` @ Jk  L BTCkDEF?SJIj @ lf  L BTCDEF?SH @ ]  L B4CDEF? 3/ @ C }  L B$CDEF?e#e @#  G  L BCNDEF?M%M @# 8A   L BCDE(F0? u0e]O'*Jn=u@(  x  L HBCDEpFx?ghD(|ohu|_4|7)F{N,7fww&4`g9<@ H P  L B>CDE\Fd?\e<, =<+_@$=4j]i52Vq\/0@ \  X  L (B|CDEF?88<r*+ iDJV @de6{yjZZ77W.Ojn -WaCi{D)Z; Go<qt@ ' 8  L BpCDEPFX?oTu0I  _3,x4_b_z"=L__zo),@  vP L BCDEF?77 FK}eaD9'_K &  X{N~kU<2#L=h #CqM`X+ 4 h(T9- Jr op@ ]  L BCFDEF?..)2o:z]:)Y}V*k?V!2Bc 2JQw} 6q%8ESA)]`@4 h L 8BC%DEF?::$$ ^$~}-\WU<mWSz4 N\zd/`N8#9 USm3x5 wG JGu$@h$ux@UG l`2 L 0? c )h L 8BC%DEF?::$` &`q}W\-u/quHm)S 4dN\ dU`N8k#K /1~Qq ?dwG :|Gou`D$ux@ G%l L ZP gֳgֳ ?"   T Click to edit Master title style! !H L TR gֳgֳ ?"\|   RClick to edit Master text styles Second level Third level Fourth level Fifth level!     S L  ` gֳgֳ ?"``   ^*  L  `< gֳgֳ ?"`    `*  L  ` gֳgֳ ?"`    `* H L 0 ޽h? ? i`80___PPT10.-\d MEDICAL  1)@P(  PT Uc% P "cU% P BXCaDEF?`WW=` @ Jk  P BTCkDEF?SJIj @ lf  P BTCDEF?SH @ ]  P B4CDEF? 3/ @ C }  P B$CDEF?e#e @#  G  P BCNDEF?M%M @# 8A   P BCDE(F0? u0e]O'*Jn=u@(  x  P HBCDEpFx?ghD(|ohu|_4|7)F{N,7fww&4`g9<@ H P  P B>CDE\Fd?\e<, =<+_@$=4j]i52Vq\/0@ \  X  P (B|CDEF?88<r*+ iDJV @de6{yjZZ77W.Ojn -WaCi{D)Z; Go<qt@ ' 8  P BpCDEPFX?oTu0I  _3,x4_b_z"=L__zo),@  vP P BCDEF?77 FK}eaD9'_K &  X{N~kU<2#L=h #CqM`X+ 4 h(T9- Jr op@ ]  P BCFDEF?..)2o:z]:)Y}V*k?V!2Bc 2JQw} 6q%8ESA)]`@4 h P 8BC%DEF?::$$ ^$~}-\WU<mWSz4 N\zd/`N8#9 USm3x5 wG JGu$@h$ux@UG l`2 P 0? c )h P 8BC%DEF?::$` &`q}W\-u/quHm)S 4dN\ dU`N8k#K /1~Qq ?dwG :|Gou`D$ux@ G%l P Z, gֳgֳ ?"p   T Click to edit Master title style! ! P T|6 gֳgֳ ?" `     W#Click to edit Master subtitle style$ $ P  `( gֳgֳ ?"``   ^*  P  `? gֳgֳ ?"`    `*  P  `8 gֳgֳ ?"`    `* H P 0 ޽h? ? i`80___PPT10.-0 ` *(     00ˋ  P   ; X*   0\΋       Z* d  c $ ?     05   0   RClick to edit Master text styles Second level Third level Fourth level Fifth level!     S  6\  _P    X*   6Y  _    Z* H  0޽h ? 3380___PPT10.\  H(  H H 0Ã P    X*  H 0ƃ     Z*  H 6 `P   X*  H 6$ `   Z* H H 0޽h ? ̙3380___PPT10.C`d)$ 0$(  r  S @ PPp   r  S  P0     H  0޽h ? i`80___PPT10.\ܯ0  p0(  x  c $ L   x  c $p LR   H  0޽h ? 3380___PPT10.\J  J(  x  c $` L      c $L Pp   &x#^6H  0޽h ? 3380___PPT10.]{  $(  r  S L0   r  S D$L3|  H  0޽h ? i`0  $0(  $x $ c $ȶL   x $ c $L   H $ 0޽h ? 3380___PPT10.^p0  ,0(  ,x , c $ ;L  ; x , c $W L\| ; H , 0޽h ? 3380___PPT10.^ ~  4(  4x 4 c $ZL Pp4   R 4 s *sx 4 <A ?? 0 H 4 0޽h ? 3380___PPT10.^P*   <*(  <x < c $L   r < S hL  H < 0޽h ? 3380___PPT10._D"  @T$(  Tr T S L   r T S @L\|  H T 0޽h ? i`  PX$(  Xr X S zL   r X S BL\|  H X 0޽h ? i` 0 P(  X  C       S pA   0    H  0޽h ? 3380___PPT10.\ 0 (  X  C       S   0    H  0޽h ? 3380___PPT10.\ 0  (   X  C       S J  0    H  0޽h ? 3380___PPT10.]} 0 ((  (X ( C      ( S 0  0    H ( 0޽h ? 3380___PPT10.^` 0 0(  0X 0 C      0 S 8(  0    H 0 0޽h ? 3380___PPT10.^ # 0 8(  8X 8 C      8 S |  0    H 8 0޽h ? 3380___PPT10.^P 0 0@(  @X @ C      @ S \~  0    H @ 0޽h ? 3380___PPT10._"(.x} t\Օ{ժ%/bYK%-cC XvXm$'v74ӤsH$'L3i8dr1"33aBHO Lg!Q8IkW$KLU^vsO{9c&,h)PI~EwŸOpG/E/_|j5kׁ~>|#&o|+_~W_ > |;w_|/kz*یO~ව ~k_ස~']w{?~?Mo𷀿{A;;?$msI8O'?$ SO# n[lc@ Se ۃBq͊}{q1zf.n-υdzA`M;r@?^!i>@y?]K(/IzǰW4QѽÎnk\8_D}g~`БǴdiQ 4t=ԗP*Y~w=eD:vϾy-_aq~ }2G1їa!&_0a"J{/2+:cKy>y0yemi^Wgj#SN|֯k#L1P`tش)yҵ[/ſgo&}&Ҫk TF'D]|߆e *3+)6u$]ԚΞȑ3#,Y$aFfTOJJ`էCqh 6Yq \02M8 &v8o9+r倇=႟V1^3Z,4^*Ns ̃)+5|mp }'k9oЏ81:A괋"wzٱQϰ }:u:=S_MQ;< uv:Ah86]p/|In} :p7x{z8 _A?ꠣoo5 Gd2 :=^y.qQxG:\65 ?GyՎrQ/ϡ4PL&\ ҹsڿG`TKp?91p} r :z0rK06!L'Jqޣb~y` > ñ/43PJ%Yf!~=XB`ehh[2U0ͤ f ]'Ό {dž2'ƴ-@m XmhdtL۳mvAS!f.M2 ؾ#p s62 L;0<6xlt13 cs6-ݑƆ5"oL0R b 2b$1D`GPE;$7ڎùZѬD n[SB׾j43&0~,'|xw4E<N&]So''ٱ=)==mkK;ڒɞEpooo{Wךwuml_XݞLuMg\#":ȶk~M'X\G&!״un#eAPlڐkA};3cyXcQ[Fá}pH 7K5јT"ZOZڒK%sT h(&>eP[voާJw iN dFV`:n;{c#c1`Aܗ0"YP2 #32|r+ړPЍWPth2NA6LF:qr,3ZTO8-7? g|XK8?hn}ΟRp Λ@+ >; E-npq)˨!WWyxOm_Ft}?t+S =`A3!Jb`?۷rj^j7o~y{{I¯1ؼ͓p( ;(tk,C18Lv<-g{?ҿk?>T6 ?^uk'.rsߖK w{SqYGۦ)gṐ/j}LQs.l|f(F7iGz_1>>n;[>M/Rx'umRz-*ϭ럄Q.;BKjr(RSG.;i}]%_0>~۲_{L=`! z6p=OTX b H T ~/Fpً!3f8 ?+}Yw܂_ G,{$l{Ēa~OYBa__ )ZE0Ndq^M0=`XV yX'E=`1XVKxTXVa`*XV#y{>Q^l^l6YME&CB)RB>#䇐 B(hJ TgB2Ba*PBF(j#P*Z#P]FmWrS)N_5:h eeWRu'gWS.X.\z%+f`ok;A_w۴ܿήP,;7_5Rp=Ejq%*X?ꛏ6亄>aMȆAA#G6I }҆uֳd[QBvPgH6 D(RBIUJ' %? (ḢK' ~HIB x=O"II蟖h$JHB&% Ք%.%[Q(F~Ot $I€'$ |=$ z) $.@ R)g+  +S"Gp0@nIJp$<% +$ A(a?x$ q)aXqKK6F S!PoiAiڔȱ lSJ$ RF woC !a Ix0G$%Y2:r!*A 9 tDC!Cu#uX:D\ \]Bd{дKAT{\c_ xEAi0ȨX/xaa[ OC , &z6?3Ꞔ_'#?Gzn V%#?'RPC6쟲6#.C5o<7 %K=?Q[Mġ8guߝk}{mG]HZ6 tc5BHAbRnmm!o;o(s+A7~@1"s?N?#cy_*KZRN32e!˒{HSS:@km,V:5Ŭtuy蟽 cɿku"ʂ(+ QWB O &1Bc^.U*+R,+V<joοJeKB=Je1LJ\.!Fc|"e8& PSeqHY#^&ړg1# GImܖ*^n?jp{B=NܖAȭ(r[_>/܎DǵF@nq*/YpU3kf74 vV VbP|E_mV(6u8n*UB o'noJ-Ŝq.dٺ4w4۠u#/|뺍6!kDeF(` BhjrZtkj%hl㌿ ޫN)j6B>E[qB+P*#T"k4^5v5ޘ!wv JޫI ޫIeդ#z_mPI#šی]z^^k5{ }̵jPFa8{B}cʹnyD<>br\MbP-上 גobש>6jS8MJx؂1* -E#Jh-: $EZ,hqL[JuRBnUC"Wͷ~4O' M '(-DM|PTSF.#n#dmf**PⰠPȸ(룝D(m0BqHkJoJZjH IWن8*POԚSk[ 7zݏ-ee2ʶ,dq8ǃXeTVEB͂"IL_:X&ظ)<C*PM%%WetG+_PT$" H@%j@F/!aa}A`r5+ȈAz[FbF+ъibF+1W$7őHVLh4Z1VLhŴbYqb. ъibF+ъibF+ъibF+ъibF+QͬZ1VLh4Z1VL +$1Hr+65ifWyuD38~5鎺xQc7fbSu$`E _lvYI+6[b2xbiEmVH]HubE+]4ho }Bʟex{ a.P)8Vp(ϸ;Of\Z0沂0woE6&`umLQ;`EwnWv0w(EweEWts;`]ѽ3p0n*g-"b4B~欃g!g_XBF7:--H҇RT&/!Pc3-iU\(g Ɨzu C aN= AM)R ӊJ r5\–6*UE7UyeLA]JFpN SnDgJsʉ_ǧγ4.}e6x5WOJ0jaJҙ} uQ1 Vi!Uq z$aP?xg *OdD\%c&?Teez 9Kxσ˕){ch 5pDqA|. 8 ") μ+/ʋ⮼zg^+/ŕKqeܻ8bg^~W^~W^~W^~W^ְqppppe_$ μJlyeiRΞfS ʼn֕oԍ /]| s")ec ޑZ#rEWnW\XtخtEWtsW\(\q=bMEd:*ס$*&wP;Tbi{ⳓo(>rq-8Аkm~'d[ϡ]ːWq1iu cEIA$XmnPҤli UtEV3z&IGuHth ${͢ΤXvd.$h:4Ja˲|ع~?i7xʫ(w[X;jX^Zp^jЪ$=]RO{!-sr#SIC=3Vϯs)f5|1a*/U*KRI%-Rǭ\zSr VUmho#*h:>_&j[j &.O\*a'zs8 !F@#Ը1v|_(QtWv8jfVWf Wf`:]Ja$e>{9]!尗o[m]QϺbY&9ZK<n_+UB([U YXs^> /4MMF}*FMN%}u L+H˵&?1/TK9s?~-⢏\_*f+q:Pq@JwC0]:f 4>5LBmeٵB*/ u,Q;I{놔skk\o\ڜr]USUk*kL9Wj)sJF܀e p}^{{Q{u4vi%wό֙Qh3P􃀴]gF:fFF~YUXpZ!QY+x0ofeZMt{ĭ0%Џ[u3nTc0J䴺Wxo1kkgJ;͐o?q_Fǎ1n!Gwߌݛ!Ag}\5 3U1$}{һ,~c5j(a{!i86x\BcW7L|So@r! ^N P\uP$Fv57VI.!H ">x*otդ6@t~=ȩRcD$1_5b@F6:n#I)FXgD"*5S#=F yDA0"nFӬ!Jj4ěEmvIT|]ʈ\Cv0̞MUܔ@D/SwKmvRt3dlT٣ft/IX<IC)ho1ޚrs x]`RI*r:r= ?jʏ8IMw'4TQJ'E^1Eݖ/4܅cI~ptGL[bmDU Rmٙ2&\]!0 :2Ol!h< s0=Ћ+`0`.w0IA+P܃;`.0s`̝͠+`0wR`oGm5Gs@'qYtI瀎-p費:Ds@9cm]k@I: NJju;tR?A:tΡjtXk@:g)t]2r#t*UzKY3^W\tq Sf^Ŕ|O=崄\bEi|)0fU1/ M)f~%XW|f$\RqC2gy!7ǿߦA+ȉ?}U3+\\y.*~H'ST0aa:a0`΀nf"YMeQ1!Rl3yGB9+ׁ<\S.R-zgzV:P :K|#.屟Y' ?_RQUJ~ Nq/_&"Ġ߯ҽD#W3e>z :Uސ#EC824#{Sb8R߻vw/.@rZ \Ye[:3`}o;,lL:a0`΀0ޟf ln}؀}؀dn2` r6ao3{ր=f3`cl̀]k5`u`r&ʇpEiwzt,̮}쎣+"}0o1kq6]Wg _E[do9KQ-VN婍B+iКYhs,7=+(U(;=07&MʞԌ,I=-kKSlwl2&Esir;.o&Ðo5973M66JT5"&|v<|̍oiywgSsErZB룓/z_Q9MZ‘/{ZB9΅{_ɶVkeﭶG:. *gz-5o=Uj|%x=h{W-=#1IkG3A&0%e_S|&)lt__AI{{?- 87[+W'e%\9y/Zvͼ|fm[- >ucy&myK۞G҈'fr=K2_ҾI[ hޤv|ɱ(+/d4'jf2ꙍ~ RFEms9z{92=+Y|oht)+彖^B%`~|6(ylFӌKn臨j*l2/gKiheBiQ{x <+{Z:GNڝaݢn.[?2hUw*fa=Kre~jw ܪdϗP[]e2_}B 3WX~#dï^c1195Z8Þ=/Ki =iqj^jh'HC[_mQ8Kx>=a~ޭAE%jiH˸uwV7W^+\/HgOM |yڸ?GT]!۷L=;a=~c5Qbcg%"WĒqup5,3g"ac\zq\+٭ HkpAZ$ݱ:}U (2#=Ɍsz3Um Ϣnm_rl Q[pq]&`suddwfyh{fk}:W cO4@xbmo, Oh+'0 hp< HT x  TDelay to EKG in STEMI Patients Does Not Preclude Meeting 90-Minute D2B Time john kellyTC:\Documents and Settings\hibays\Application Data\Microsoft\Templates\MEDICAL.POT 14Microsoft Office PowerPoint@0r@`7\@/CGg   x   --$--'--$(ee"(--'--$NIN--'--$--'--$&*&--'--$WFI]W--'-- $x~--'--$ }vpw}--'--<$e`ZUNF ?8"  ")BGOT_e--'--2$(07:962,(" !! --'--t$8|tmf_YUPQ%bpz ~xnc\QG<3,),3<DJQY^]YSF .CJS[clsz--'--,$tng_XQIB9BJRZbj pv{--'--r$70 +" -:EKxQqQfO\KTFM>E6?1<)7 AIP&V-]1f.o$w~  ")0--'--`$.) {upmlnpuz #&),.-)--'--x$:taTIA<HPU[K=.!#(' "Kymqifeefiqy~~--'--F$!=>?@BEHKNRUX[]^_`_^][XURNKHEB@?>=--'--x$:#-7ALV^RKD@ReqyyqYiHf;e/e'f iqy~ ~--'@"Verdana-. (2 Delay to EKG in STEMI .%%$&&+-('&&4.. (2 Delay to EKG in STEMI .%%$&&+-('&&4."System-@"Verdana-. "2 Patients Does Not )%%'!.&%!/&.. "2 Patients Does Not )%%'!.&%!/&.-@"Verdana-. '2 Preclude Meeting )%!''%5%$('.. '2 Preclude Meeting )%!''%5%$('.-@"Verdana-.  2 M90((..  2 K90((.-@"Verdana-.  2 M-..  2 K-.-@"Verdana-. 2 MMinute D2B Time5('%.'+&;%.. 2 KMinute D2B Time5('%.'+&;%.-@"Verdana-. 32 John J. Kelly, Jeffrey Cohn,  .. 32 John J. Kelly, Jeffrey Cohn,  .-@"Verdana-. 12 D.Lynn Morris & Sharon Hibay"%  ! .. 12 D.Lynn Morris & Sharon Hibay"%  ! .-@"Verdana-. 42 JAlbert Einstein Medical Center   &   .. 42 IAlbert Einstein Medical Center   &   .-՜.+,0    MOn-screen Showľ%  ArialVerdanaMonotype Sorts Book AntiquaMEDICALMicrosoft Excel ChartRDelay to EKG in STEMI Patients Does Not Preclude Meeting 90-Minute D2B Time Background Background Background ObjectiveMethodsResults Conclusions Conclusions Limitations  Fonts UsedDesign TemplateEmbedded OLE Servers Slide Titles _㠮    !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_abcdefghijkmnopqrsuvwxyz{~Root EntrydO)PicturesCurrent UsertSummaryInformation(`PowerPoint Document(ĮDocumentSummaryInformation8l