OHSU Chest Pain Program DATE: March 14, 2017 PRESENTED BY: Joaquin Cigarroa, MD Clinical Chief Knight Cardiovascular Institute Rachel White, MSN, RN, CCRN Chest Pain Coordinator

OHSU Chest Pain Program Mission To bring together individuals who manage patients with chest pain throughout OHSU and the community and to design the optimal chest pain management program. Vision To be a Vizient Top 10 Chest Pain Program nationally and to improve access and quality of care for all Oregonians.

OHSU Chest Pain Program STEMI patients 2017: 89 2016: 103 2015: 65 2014: 64 2013: 89 2012: 135 3

OHSU Chest Pain Program Of the OSH transfers: 31 s/p lytics and 21 direct to CCL 4

OHSU Chest Pain Program KCVI Cardiac Ischemia CQI Committee is a multidisciplinary team that oversees the care of all ischemic heart disease patients at OHSU Active participation in multiple registries including NCDR, CathPCI, ACTION—GTWG, STS (CABG only) and UHC KCVI is an integrated center for translational research, clinical care, professional training and outreach in all aspects of heart and vascular disease. 5

Rapid Response Team 24/7 Availability Support inpatients as well as ED and incoming critical care transfers Stroke and STEMI response team members Initiate and progress care for STEMI patients after hours/weekends 6

Nursing Support of Chest Pain Patients CVICU Gold Beacon Award winner x4 Certification: 80% of qualified RNs, and 92% for RRT Active nursing research (IRB approved) for early warning scoring system, Mock Codes, and CALS Cardiac Cath Lab Certification: 67% of eligible RNs EBP Fellowship Hematoma Project

Nursing Support of Chest Pain Patients CVIMC Certification of 60% of eligible RNs Presentation at two nursing conferences on “Fostering a Culture of Safety through Interdisciplinary Improvement Rounds” Two Good Catch awards Multiple rose awards 3 Daisy Awards over the past 2 years

2016 ACTION Registry — GWTG Silver Performance Achievement Award Q4 2014 Q1 2015 Q2 2015 Q3 2015 Q4 2015 Q1 2016 Q2 2016 Q3 2016 Metric 1: Overall AMI performance composite   Metric 2: Overall defect free care Metric 3: STEMI performance composite Metric 4: NSTEMI performance composite Metric 5: Acute AMI performance composite Metric 6: Discharge AMI performance composite Metric 9: Beta-blocker at discharge Metric 10: Statin prescribed at discharge Metric 12: ACE-I or ARB for LVSD at discharge Metric 15: Proportion of STEMI patients receiving primary PCI within 90 minutes Metric 16: Median time in minutes to primary PCI for STEMI patients Metric 18: Time in minutes from ED arrival at STEMI referral facility to ED discharge from STEMI referral facility for patients transferred for PCI Metric 19: Time in minutes from ED arrival at STEMI referral facility to Primary PCI at STEMI receiving facility among transferred patients Metric 22: Door to 1st ECG in minutes Metrics 40: Pre-hospital ECG >= 50th %ile < 50th %ile > 90th %ile < 10th %ile

OHSU Chest Pain Program Commitment to Community ED/EMS STEMI Committee comprised of ED, EMS, and Interventional Cardiology representatives that review STEMI cases quarterly evaluating for quality and process improvement opportunities Annual EMS Conference Participant in Accelerator II project with Portland regional hospitals, AHA, and Duke University Support the annual Oregon ACC Conference 10

OHSU Chest Pain Program Commitment to Community OHSU Chest Pain Coordinator co-chairs Regional STEMI Coordinator group Share best practices with community hospitals seeking to develop standard work when providing care to STEMI patients Provide community providers access to participation in our didactic and case based conferences 11

Thank You