1. Regional Showcase West Tennessee

2. Speakers: John Baker M.D./Emily Garner RN Presentation: Regional Showcase – West Tennessee Presenter Disclosure Information FINANCIAL DISCLOSURE: No relevant financial relationship exists

3. Jackson Madison County General Hospital The flagship of West Tennessee Healthcare is a 635- bed tertiary care center. The only tertiary care hospital between Memphis and Nashville, the hospital serves a 17-county area of rural West Tennessee. Approximately 551,000 persons reside within the service area. Within General Hospital, there exists six 'centers of excellence': the West Tennessee Heart and Vascular Center, Kirkland Cancer Center, West Tennessee Women’s Center, West Tennessee Rehabilitation Center, West Tennessee Neuroscience and Spine Center, and Emergency Services. Each center has an historic reputation of 'high-tech, high-touch' skills.

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6. West Tennessee System Cardiac Coverage Area 18 Counties Hospitals 16 Acute Care Hospitals 2 PCI Receiving Facilities 1 PCI Receiving Facility with CV Surgery Back-Up EMS Systems 17 Ground EMS Services 10 Air EMS Bases (between 2 Different Air Services)

8. . MeasureInitial State Door to EKG Completion21% of all cases = 5 minutes 50% of STEMIs = 5 minutes Door to STEMI Diagnosis70% of cases = 10 minutes 83% of STEMIs = 10 minutes Door to Cath Lab Activation74% of cases = 15 minutes Door to Arrival CCL Team83% of cases > 40 minutes Door to Device Deployment (Door to Balloon Time) 35% of cases ≤ 90 minutes JMCGH STEMI Mortality Rate25% Initial State

9. Target State Target State Chest Pain patient arrives ECG done STEMI? No Yes ED Activates CCL Member 1 arrives Patient Moved to CCL with 2 ED Nurses CCL Member 2 arrives Chest Pain Unit for obs Patient Prepped Patient Transferred From Stretcher to table CCL Member 3 & Cardiologist arrives Arterial Access By MD Balloon Inflated ED – ECG Goal: 10 min ECG - CCL Goal: 45 min CCL - Balloon Goal: 35 min New Process for STEMI Patients

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11. Challenges Education – Hospital Administration, ED, EMS, Nursing Rural Based Areas – long travel times (selection of transport mode) Transmitting EKGs - Funding STEMI Walk-Ins – Community Education on Calling 911 Preparation Time – Door In Door Out Times ED Accepting Transfers Communication/Data Feedback

12. Successes  Education to all West TN Hospitals and EMS Systems o Guidelines/Times o Early Recognition/Training o Early Activation of Transport o EKG Transmission/Fax  Development of Co-Management Contract with Cardiologist  Annual STEMI 12 Lead EKG Training o Program with Med Center EMS, Air Evac Lifeteam

14. Successes  Quarterly Regional STEMI/Chest Pain Center Accr. Meetings o Web/Conference Available o Monthly Internal Meetings  Network Visits – Building Relationships is KEY!  Auto Accept/One-Call Policy  Resources  Conference Calls for Transfers  Community STEMI Drills  Feedback Data  10-10-10 Plan  STEMI Treatment Zones/Map

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18. Successes  Collaborating with other Facilities for their CPC Accreditation  Community Education on Signs/Symptoms/Calling 9-1-1  Events/Ads  Importance of Bystander CPR – Pulse Point Free App  Survive Don’t Drive Campaign - https://www.youtube.com/watch?feature=player_detailpage&v=dQ H8LfbzmtM https://www.youtube.com/watch?feature=player_detailpage&v=dQ H8LfbzmtM

20. Source: NCDR Registry – PCI - Metric #16 Owner: W.TN Heart & Vascular Center 50 th = 59.2 mins 90 th = 47mins

23. Source: NCDR Registry – Action - Metric #6 Owner: W.TN Heart & Vascular Center 50 th = 107 mins 90 th = 80mins

24. Source: NCDR Registry – PCI - Metric #18 Owner: W.TN Heart & Vascular Center 50 th = 44.8 mins 90 th = 27.8 mins

26. Achievements/Awards  2014 Women’s Choice Award for Best Heart Care Based in performance in the following categories: America’s Best Hospitals for Heart Failure Care America’s Best Hospitals for Heart Attack Care America’s Best Hospitals for Patient Satisfaction  2014 NCDR/ACTION Platinum Performance Achievement Award

30. Remaining Challenges  Delayed Times in DD2B/DIDO  Outside Limited Resources  ED Physician Turnover  EMS FMC to PCI <90 minutes – Mission Lifeline Recommendation

31. Contact Info: emily.garner@wth.org jbaker@jacksonclinic.com