In order to create the visibility of the project, it is useful to apply a tree diagram.
The tree diagram is a structured hierarchical list of objectives, in which lower-level targets are the basis to achieve higher-level goals. Accordingly, the paramount goal stays on the top. As the achievement of strategic goals might be difficult to some extent, it is necessary to perform the decomposition of the goal that is the extension into smaller ones, the cumulative accomplishment of which leads to the successful achievement of the main goal.
In its turn, the SMART goals tool is a modern approach to the formulation of operating objectives. It allows summarizing all the available data on the goal-setting stage to determine clear, precise, and specific objectives (Lee, 2010). SMART is an abbreviation that includes the following elements: Specific, Measurable, Achievable, Relevant, and Time-Bound. It seems significant to consider each criterion in detail focusing on results of needs assessment, data analysis, and literature review of the DTB in the STEMI patients.
The marked goal is undoubtedly specific in terms of its necessity. More and more STEMI patients are dying from inappropriate and untimely emergency medicine. In particular, DTB in STEMI patients causes the most anxiety as the number of people who died from it not only remains but also increases all over the world. Therefore, it seems rather significant to elaborate the SMART goals with the help of the tree diagram. It clearly demonstrates the stated goals, the visibility of which will contribute to the creation of a change project plan (Anonymous, 2014).
First, it seems very important to focus on change planning among the personnel. In order to achieve cooperation, representatives of all disciplines should consider the further strategy for a certain patient. The primary goal is to do for other people what they cannot do for themselves providing them with appropriate and timely health care. The goal is measurable as there are plenty of tools to assess its efficiency of it. Particularly, the use of qualitative along with quantitative measures would assist in evaluating the effectiveness of conducted measures.
It is also should be noted that the goal is attainable. One should note that modern hospitals possess all the required equipment to ensure appropriate and timely health care. Moreover, the majority of doctors and nurses are professionals who are able to provide STEMI patients with necessary help if required and decrease DTB intervals.
Currently, the treatment of patients with acute myocardial infarction is achieved in stages by paramedics, physicians, and the emergency department of interventional cardiology. Now, it is the time when these services have to act as a team. At present, when the prehospital ECG diagnosis is possible, paramedics, in other words, doctors of first aid might directly notify intervention cardiologists and patients to deliver immediately to the operating room. Besides, the person should act on a collegial basis rather than the superior-subordinate relationships (MacLeod, 2012). It might be implemented by means of EMS dispatch (Stowens, Sonnad, & Rosenbaum, 2015). What is more, the personnel training and examination of their competence should be an integral part of the change project plan (Joost, Blumrath, & Radke, 2012). According to Selvaambigai (2012), “Creating a program that supports the routine use of evidence-based practice can seem complicated and time-consuming. A successful program includes built-in organizational support for the clinical inquiry, functional and efficient processes for EBP activities, to sustain momentum and interest over time” (p. 78). The above proves the relevance of the goal and reflects ways to decrease DTB times in STEMI patients.
The goal might be considered time-limited. There are some time-bound changes that seem important to implement in practice. First of all, the doctor of the admission department should not wait for approval by a cardiologist to the patient’s referral for the intervention. Secondly, several organizational issues, each of which can win a small amount of time might be taken into account: the direct telephone or EMS dispatch communication between the admission department and the department of interventional procedures should be established; lift between the two departments should follow without interruption and delay; parking for an ambulance should be reorganized in order to give priority to patients with a heart attack, who need the intervention. As a result, the time from hospitalization to performing electrocardiography and then intervention would significantly decrease.
It goes without saying that the smaller the DTB interval, the greater the likelihood of success of the reperfusion intervention, and the better the prognosis for the patient. The paramount goal of the project is to reduce DTB intervals in STEMI patients to less than 60 minutes, namely, to 45 minutes. Therefore, the results of this study are very important for clinical practice. It is expected that the implementation of these goals would be an important factor for reducing mortality among patients with STEMI.
Anonymous. (2014). How to create smart goals using a tree diagram. Journal of Staff Development, 35(6), 54-57.
Joost, A., Blumrath, C., & Radke, P. (2012). TCT-485 A simple strategy to significantly reduce the “door-to-balloon” time in patients with acute ST-elevation myocardial infarction. Journal of the American College of Cardiology, 60(17), 140-142.
Lee, K. P. (2010). Planning for success: Setting SMART goals for the study. British Journal of Midwifery, 18(11), 744-746.
MacLeod, L. (2012). Making SMART goals smarter. Physician Executive, 38(2), 68-72.
Selvaambigai, V. R. (2012). Infusing nursing research into practice for quality care. Nursing Journal of India, 103(2), 77-78.
Stowens, J., Sonnad, S., & Rosenbaum, R. (2015). Using EMS Dispatch to Trigger STEMI Alerts Decreases Door-to-Balloon Times. Western Journal of Emergency Medicine, 16(3), 472-480.