1. Where is Cookeville Regional Medical Center? 0 Cookeville Regional Medical Center STEMI program (What we do well and our challenges) Commercial Interest (None) “No relevant financial relationship(s) exist.” Brenda Davis-Bryant RN November 7 th 2014

2. 1 Where is Cookeville Regional Medical Center?

3. 2 Ø247 Beds Ø2 Catherization Labs / 1 additional pending Ø1 EP Lab (Opened 2010) Ø10 Cardiologists which includes 4 Interventionalists and 1 Electrophysiologist Ø2 CVOR Suites Ø3 CV Surgeons and 3 CV Anesthesiologists ØSCPC PCI Accreditation / Cycle IV ØCurrent D2B 42 minutes ØUniversal STEMI acceptance

4. 3 KY EMS Receiving Counties 14

5. 4 KY Transferring Facilities LRH 8 CRMC

6. 5 KY Established Cardiac Clinics TN Heart Offices 6

7. 6 What CRMC is doing well. ØMaintaining a good working relationship with all EMS and air transport agencies.

8. 7 ◊ Providing timely STEMI feedback to agency

9. 8 ◊ Host a Bi-Annual CRMC and Upper Cumberland EMS Collaboration Luncheon. CRMC attendees include Senior Management, (CEO, CMO, COO, CNO) Department Directors, Cardiology, and Managers. Upper Cumberland attendees include all EMS agency directors and their lead staff, all air transport agency directors and their lead staff, and senior management from transferring facilities. We usually have two speakers: One for medical topics and Cardiac interventionalist presents Case Studies of STEMI’s

10. 9 ◊ CRMC provides Critical Care Course for Paramedics. (Currently on 5 th Cycle) This reinforces our commitment to EMS agencies of the Upper Cumberland area.

11. 10 Travel to all 14 counties (EMS Stations) two to four times each year giving updates, re-educating, providing educational videos. Addressing any issues EMS agency may be having concerning CRMC. These trips also include the Liaison visiting and maintaining collaborative relationship with transferring facilities of the Upper Cumberland area. EMS Liaison Interaction

12. 11  More than 80% of incoming STEMI patients are met by Cardiologists in the ED or ambulance bay prior to transport to the Cath Lab. We encourage EMS personnel to stay and observe the procedure.

13. 12 Organize STEMI drills with EMS agencies, air transport, and transferring facilities. Once the drill is over, we have a debriefing which includes reviewing the timeline. We discuss areas that performed well and areas for improvement. Attendees include EMS crew and EMS Director; air transport crew and air transport director, transferring facility management; ED Director, CVICU Director, Cardiac Interventionalists, STEMI Medical Director, Cath Lab Medical Director, Cath Lab Director and Manager, STEMI Coordinator.

14. 13 Organize educational events regarding our STEMI program with EMS agencies and transferring facilities.

15. 14 Cardiologists, ED Medical Director and STEMI coordinator appear at several speaking events throughout the year. Examples: Womens’ Heart Event Hospital Board of Trustee meetings Formal organizations throughout Upper Cumberland area State wide organizations Senior Citizen groups in various counties Mended Hearts

16. 15 Our Challenges

17. 16 Changes in ownership and management with transferring facilities. We are working toward rebuilding and fostering collaborative relationships again.

18. 17 Achieving and maintaining Door in and Door out of less than 30 minutes from transferring facilities.

19. 18 Changes in staff and management of EMS agencies, air transport agencies. We have to identify which counties have changed staffing and provide opportunities to educate about our STEMI program. This is usually identified when a delay is encountered at some point in our STEMI timeline.

20. 19 Budget Constraints and Time Constraints We are all under budget constraints. This is just the nature of the times. We are asked to achieve a higher level of performance with the same or even less budget than was previously allowed. Unfortunately, time constraints fall into this category too. Efficient time management is essential to continue at a higher level of performance.

21. 20 Questions?