The New Washington State Emergency Cardiac and Stroke System: Developing a Best Practice Plan for Your Community Bev McCullough Quality Improvement Manager,

Slides:



Advertisements
Similar presentations
Stroke Care is a Team Sport
Advertisements

Part I: STEMI BootCamp The 5 “R’s” of Reperfusion”
Chapter 3 for 12 Lead Training -Precourse-
MACK HUTCHISON, BS, AS, NREMT-P QUALITY MANAGER. HISTORY OF EMS The good Samaritan rendered aid to a man laying on the side of the road. Napoleon’s chief.
Inquiry into Public Hospital Performance Ambulance Victoria Presentation 2 December 2009.
Interdisciplinary Approach to Stroke Patients Stormont-Vail HealthCare Primary Stroke Center.
Alabama Acute Health Care System Alabama Acute Health Care System System Information/Education.
Status of Washington State Emergency Cardiac and Stroke System Kathleen Jobe, MD FACEP Chair, Emergency Cardiac and Stroke Technical Advisory Committee.
The Power of the Glove: Rural EKG Transmission A Pilot Study among E.M.S. Providers to Expedite Rural Heart Attack Care One Year Later….. Angela Powell,
Cardiac Reperfusion Team Protocol Reduces Door-to-Balloon Time at Hamot Medical Center Antonios D. Katsetos, DO, Thomas Williams, MS, Theresa Kisiel, CRNP,
Minnesota Acute Stroke System Council WebEx/Teleconference Meeting April 27, 2011.
Illiana RACER - When Every Second Counts Brought to you by Union Hospital’s Richard G. Lugar Center for Rural Health 1.
EMS and D2B in Pennsylvania Douglas F. Kupas, MD, FACEP Commonwealth EMS Medical Director Bureau of EMS PA Department of Health.
Regional Systems of Care to Optimize Timeliness of Reperfusion Therapy for STEMI: The Mayo Clinic Protocol Henry H. Ting, MD, MBA Associate Professor of.
Maine Emergency Medical Services Department of Public Safety Maine Heartsafe Communities Welcome.
Ann M. Hoff, MD ETC Physician Trinity Health. American Stroke Association  Guidelines for the Early Management of Adults with Ischemic Stroke (2007)
New York City Direct Referral to Catheterization Lab STEMI Notification & Transportation Protocol.
An Immediate Nursing Feedback Program for Primary PCI for ST-segment Elevation Myocardial Infarction Karen Mckenny RN, Theresa Fortner RN, Cheryl McNeil.
Mid America Stroke Network Founded By: Saint Louis University Hospital (SLU Hospital)
Process to Improve Stroke Care Reduce time to brain imaging Partner with EMS to improve skills & early identification Enhanced ED response & evaluation.
Acute Stroke Management in Northern Nevada and the Sierra Slopes A Model for Rural Stroke Care Paul M. Katz, M.D. Medical Director Washoe Comprehensive.
Stroke Alert at Lutheran General Hospital, Park Ridge, IL
The Future of Stroke in Your State: Kansas Janice Sandt MS,BSN,RN,CCM FINANCIAL DISCLOSURES: None UNLABELED/UNAPPROVED USES DISCLOSURE: None.
Systems in Acute Stroke Care Andy Jagoda, MD Professor of Emergency Medicine Department of Emergency Medicine Mount Sinai School of Medicine New York,
Templates for Organizing Stroke Triage. Getting Started Physicians Hospital administration Medical Society Hospital Council Stroke survivor groups Other.
Deploying Care Coordination and Care Transitions - Illinois
Very Rapid Treatment of STEMI: Utilizing Pre-Hospital ECGs to Bypass the Emergency Department Kenneth W. Baran, MD Medical Director for United Hospital’s.
Improving the System of Care for STEMI Patients 1.
Acute Coronary Syndrome. Acute Coronary Syndrome (ACS) Definition of ACS Signs and symptoms of ACS Gender and age related difference in ACS Pathophysiology.
Arkansas Department of Health Trauma Overview. Act 393 of 2009-Trauma System Act Trauma System: an organized and coordinated plan within a state that.
The Heart of the Matter A Journey through the system of care.
Dripping and Shipping Theda Clark Medical Center Appleton Medical Center Sheila Barr, RN Kristin Randall, RN Stroke Program Coordinators.
1 Utilizing Advanced Practice Paramedics to Reduce Hospital Readmissions Presented by: Kevin Yarrow Senior General Manager VITAS Innovative Hospice Care.
“What every Iowan can expect from Emergency Medical Services”
Regional Showcase West Tennessee. Speakers: John Baker M.D./Emily Garner RN Presentation: Regional Showcase – West Tennessee Presenter Disclosure Information.
Door to Balloon Times: How we got to where we are Brittany Cunningham, RN, MSN VHVI Quality Consultant July 27 th, 2011.
15: The ‘Admin’ Question Patient flow Dr Tony Kambourakis.
9-1-1 COORDINATION WORKGROUP Samar Muzaffar, MD MPH.
Time Critical Diagnosis Rural-Urban Workgroup Samar Muzaffar, MD MPH.
California Stroke Registry Right Care Initiative Meeting August 13, 2012.
Virginia Heart Attack Coalition/Mission Lifeline.
National AMI Information Call February 5, 2008 Patient Safety Initiative.
Confidential. This presentation is provided for the recipient only and cannot be reproduced or shared without Tennova Healthcare, Inc.’s express consent.
 Demographics  Estimated Population 10,500  Population of Zip Code 29,000  21% of population 65 or older  Satellite Beach Fire & Paramedic.
Chattanooga/TriState Regional Update 2015 Robert L. Huang, MD MPH UT Erlanger Health System.
Acute Myocardial Infarction February 8, 2006.
When You Call 911 Emergency Medical Technicians - Paramedics.
{ Challenging Case Presentations From South Texas Methodist Hospital REGIONAL SYSTEMS OF CARE DEMONSTRATION PROJECT: MISSION: LIFELINE™ STEMI SYSTEMS ACCELERATOR.
11 Kansas Heart & Stroke Collaborative September 22 and 23, 2014.
Heart Alert Quandary Kiran K. Cheruku, MD Interventional Cardiologist Heart And Vascular Institute of Texas.
Overview of the Winnipeg CODE STEMI Project Implemented May 2008 Dr.J.Tam MD, FRCP(C), FACC Section Chief Cardiology WRHA and University of Manitoba Lillian.
Emerging Infectious Disease Tabletop Exercise
Telemedicine To Expedite Patient’s Transfer: The Introduction of the Videophone Lowell Satler, MD Washington Hospital Center.
Prof Kim Myeong Kon / R1 Park Ji Yoon
Challenging Case Presentations From South Texas Methodist Hospital
Trauma and Stroke Improved Outcomes in Utah Hospitals
Optimising STEMi Care- Role of Nurses and Paramedics
Community Education Goal
Metro STEMI Task Force The Central Iowa EMS Directors STEMI Task Force is striving to improve the patient outcomes of ST elevation myocardial infarctions.
Eva Kline-Rogers RN, NP, AACC University of Michigan
STEMI Systems of Care – Update on Mission: Lifeline:
The Model Patient and Model EMS
ED STROKE ALERT Competency
Brief History on Mission: Lifeline
Community Step Up Program
Agenda What and why? Regional system components Path forward.
Telestroke Network Program Implementation and improved Stroke Care Delivery in an Urban Healthcare System Katja G. Bryant Neuroscience Clinical Specialist,
CRITICAL/CLINICAL PATHWAYS ACUTE CORONARY SYNDROMES
Statewide System of Care for Stroke in Arkansas 2019 AR SAVES Telestroke Conference September 26, 2019 James Bledsoe, MD,FACS State EMS and Trauma.
Presentation transcript:

The New Washington State Emergency Cardiac and Stroke System: Developing a Best Practice Plan for Your Community Bev McCullough Quality Improvement Manager, RHQN Kim Kelley, MSW Planning Coordinator, WA State DOH

The Washington State Emergency Cardiac and Stroke System: Creating Opportunities Together Kim Kelley, MSW Cardiac/Stroke Systems Coordinator WA State Department of Health

The Continuum of Care Prevention PrehospitalHospitalSecondary Prevention/ Rehabilitation System Evaluation

Working together across the continuum we can coordinate care and find efficiencies in the system to reduce time to treatment and improve outcomes for our patients. Creating Opportunities Together…

Washington’s Population is Aging Annual Change in Population Ages 65 and Over

Risk Factors Are Increasing

The Chain of Events Emergency Cardiac and Stroke System Physical Inactivity Poor Diet Tobacco Use Chronic Stress (Risk Factors) Diabetes Hypertension High Cholesterol Obesity (Diseases & Conditions) (Events/Deaths) Medical/Health Homes Healthy Communities

The Bottom Line A rapidly aging population and increasing rates of obesity, diabetes, and high blood pressure mean more people at risk for heart attack, cardiac arrest and stroke.

Emergency Cardiac and Stroke Care in Washington Problem: effective treatments are available--but too many people don’t get them at all or in time Only 4% strokes get t-PA Only 35 of 95 hospital administered t- PA Estimated 39% of heart attacks get PCI Only 55% of hospitals give lytics under 30 min OHCA survival rates very low

The Solution An organized system to get the right patient to the right place in the right time, just like we do for trauma.

D2B Time and Mortality

SSHB 2396 Passed 2010

System Components EMS protocols for the identification, treatment, and triage of ACS and stroke patients Hospital categorization Commitment to implement best practices to improve outcomes Data driven quality improvement across the system

Hospital Categorization Program 65 of 95 hospitals applied by 1/31/11 12 more applied by 5/31/11 Notice of categorization sent to all hospitals. List sent to Regional Councils, EMS Councils Lists will be on ECS website soon

STROKE CENTERS AND COVERAGE AREA 2007 I

STROKE CENTERS AND COVERAGE AREA 2011

CARDIAC CENTERS AND COVERAGE AREA 2007

CARDIAC CENTERS AND COVEREAGE AREA 2011

Quality Improvement SHB 2396: Requires QI of participating hospitals Allows the trauma QI programs to evaluate emergency cardiac and stroke care delivery

ECS System Measures and Goals 15 minutes on-scene time for EMS 30 minutes in transfer hospital (AMI) 30 minutes door-to-needle (lytics, AMI) 60 minutes door-to-t-PA (stroke) 90 minutes first medical contact (EMS or transfer hospital) to definitive treatment 120 minutes symptom onset to definitive treatment Participating hospital within 1 hour from every citizen Cardiac arrest goals - to be determined

Outcomes Discharge status Length of stay 30-day readmission/30-day mortality Immediate and one-year mortality Function at 3 months Quality of life Ejection fraction Neurologic status

What You Can Do… Make your hospital part of the prevention cycle. Educate your communities: CPR, signs and symptoms of heart attack and stroke, and to call immediately. Become cardiac and stroke centers and implement best practices.

What You Can Do… Work with your EMS partners and fellow hospitals to create comprehensive regional systems. Collect data and use it to figure out what works and what doesn’t. Participate in the statewide ECS TAC.

Kim Kelley Cardiac/Stroke Systems Coordinator Thank you!

Kittitas Valley Community Hospital (KVCH) to Door to Balloon at Yakima Regional Medical & Coronary Center (YRMCC) > 2.5 HoursGoal < 90 minutes KVCH Throughput> 60 MinutesGoal < 30 minutes KVCH Door to EKG> 15 MinutesGoal < 5 minutes

Every patient taken to Kittitas Valley for initial assessment and stabilization EKG’s done by Respiratory Therapy only Chest X-Ray obtained “per protocol” EMS left the hospital, then were called back to transport patient to YRMCC Lab No partnerships established and varying “trust” of the assessment of our EMS providers Patients from KVCH taken to Yakima Reg. ED, reassessed & then cardiac cath team called

A focus on “what is right for the patient” All partners at the table to develop standardized protocols and training of EMS providers EKG performed in the field- if obvious STEMI and stable, EMS bypasses KVCH EMS notifies YRMCC directly - cath lab notified EMS bypasses Yakima ED - go directly to cath lab

Only unstable STEMI patients transported to KVCH Implemented a STEMI Alert Eliminated “wasteful” steps- Chest X-Ray Multiple staff trained to perform EKG EMS remains on scene when possible, ready to transport to YRMCC Cath Lab One call to YRMCC- single line for referrals

The call is dispatched for a patient experiencing chest pain. Volunteers from Cle Elum Fire Department respond, along with two off duty Medic One paramedics. Paramedics are on scene at 12:51 (<8 minutes from time of initial call). Patient diaphoretic and short of breath; reporting 10/10 substernal pain radiating to both arms. Transport from scene at 13:08.

At 13:10 12-Lead ECG transmitted to YRMCC STEMI protocol initiated. By 13:28, Cheryl received x3 NTG SL, 25mcg Fentanyl IVP 324 ASA PO, 600mg Plavix IVP and 5000 units Heparin IVP Patient reports being pain free by 13: Cath Team Called in to YRMCC 1415 Medic Unit arrived at YRMCC 1418 entered cath lab with team waiting for her

Upon arrival at cath lab: Reperfusion at 15:15

Transfer success of the STEMI Program to our Stroke Program EMS performs a FAST exam in the field and notifies KVCH of a “Stroke Alert” Developed a joint NIHSS- EMS initiates the NIHSS in the ambulance, ED staff utilize the same form to assess patient on arrival Patients taken directly to our CT, EMS reports to ED provider and RN cares for patient in CT “Door to CT” time <25 min in 75% of patients Average Door to CT Read = 30 minutes

Cheryl and attending paramedic Beth Williams; Winter, 2011.

Upper Kittitas County Medic One- HD #2 Cle Elum Fire Department Kittitas Valley Community Hospital Kittitas County EMS (KITTCOM Dispatch) Kittitas Valley Fire & Rescue Yakima Regional Medical & Cardiac Center Virginia Mason Medical Center (Stroke)

Rural “Best Practice”: Community Education Tom Martin, Administrator Lincoln Hospital Davenport, WA

Initial Level One Newspaper Ad

Cardiac Level One Brochure

Stroke Billboard/Poster

Lincoln’s Stroke Program Developing a program for the future Lincoln Hospital bridges the gap in rural healthcare with robotic doctor (Davenport, Wash. )— Lincoln Hospital has announced the placement of a remote physician presence robot that will expand the delivery of specialized health care to patients in their service area. On September 20 the robot will be active at Lincoln

Co-Managing Complex Patients The Accountable Health Home RHC & CAH Tertiary and Specialty Services Optimizing Quality Outcomes, Cost and Access

Lincoln’s Robot: Part of the Team

Washington Rural Emergency Cardiac and Stroke Systems……

Working together across the continuum we can coordinate care and find efficiencies in the system to reduce time to treatment and improve outcomes for our patients. Creating Opportunities Together…

Questions? Thank you to Kim, Paul, Rhonda and Tom!