Advanced Practice Nurse Piscataway, New Jersey, United States
Background: During cardiac catheterization quality metrics review, it was identified by the lead cath lab APP (advanced practice provider) that serum lactate was inconsistently measured during STEMI activations by the emergency department (ED) or cath lab team.
Methods: In 2024, there were 132 STEMI activations recorded. A quantitative review and manual data abstraction by the lead cath lab APP revealed that only 21 activations (16%) had serum lactate measured during STEMI activation. Further drill down identified that 11 activations (8%) trended the lactate level throughout inpatient hospital stay. A multidisciplinary quality improvement project was implemented by the lead cath lab APP during Q4 of 2024 in response to the above metrics.
Outcome: Serum lactate measurement was proposed to be added to the STEMI and chest pain order sets as a hard stop in the electronic health record upon ED triage through committee review and approval processes. For those patients that bypassed the ED to be brought directly to the cath lab (on hours), the cath lab APP would enter the initial serum lactate order to be drawn during catheterization as well as subsequent trend orders for the first 24 hours. Handoff would be provided to the critical care APP or intensivist to continue trending serum lactate until clearance was achieved. Comprehensive education on serum lactate and its use and importance in the identification and management of cardiogenic shock was provided by the cath lab APP to the cath lab, ED and critical care teams, including review of how to order serum lactate and trend parameters in the electronic health record.
Conclusion: Manual data abstraction of serum lactate measurement was performed for the first three quarters of 2025. A notable 60% increase in compliance of ordering serum lactate and trend parameters was achieved, with the most success on hours when ordered and trended by the lead cath lab APP.
