1. Confidential. This presentation is provided for the recipient only and cannot be reproduced or shared without Tennova Healthcare, Inc.’s express consent. © 2011, Tennova Healthcare, Inc. Tennova Heart Institute Regional Showcase-East TN 11/7/2014 Robert Brown, RN STEMI/Stroke Coordinator

2. © 2011 Health Management, Inc. Confidential. 2 Faculty/Presenter Disclosure Information Elements Robert A. Brown, RN STEMI/Stroke Coordinator Regional Showcase-East TN Tennova Healthcare FINANCIAL DISCLOSURE: No relevant financial relationship exists

3. © 2011 Health Management, Inc. Confidential. 3 Tennova Heart Institute For almost four decades, the physicians and staff of Tennova Heart Institute have led the way in bringing the latest cardiac treatments and technology to East Tennessee. This talented and experienced team continues to bring world- class heart care straight to patients. Our comprehensive cardiac team is dedicated to finding better ways to treat and beat heart disease.

4. © 2011 Health Management, Inc. Confidential. 4 Tennova Heart Institute Tennova Heart Institute offers: 27 Board Certified Cardiologists Multiple facilities located throughout 16 county service area Interventional Cardiology » PRMC and TCMC Cardiovascular Diagnosis and Imaging Comprehensive heart failure care Prominent open heart surgery program Regions first accredited chest pain centers » PRMC and TCMC Vascular Medicine Heart Rhythm Disorders Clinical Trials Minimally invasive techniques to unblock arteries and improve blood flow Heart, Vascular and Pulmonary rehabilitation services that combine education, support and exercise therapy

5. © 2011 Health Management, Inc. Confidential. 5 Tennova Heart Institute STEMI Project Scope of Problem: The NCDR (National Cardiovascular Date Registry) ACC (American College of Cardiology) ACTION reports median Door to Balloon time from Q4 2013 is 48 minutes, placing Tennova Heart in the 50 th percentile of the participating ACTION facilities in the US. Goal: To reduce Tennova Heart median Door to Balloon times, reported by the NCDR, from 62 minutes to the 90 th percentile in the US, placing Tennova Heart in the top 10 percent in the country by December 31 st 2014. Team: Medical Directors »Dr Mehta »Dr Hookman STEMI Coordinators »De Rauhuff - TCMC »Robert Brown - PRMC Executive leaders, ED Staff, Cath Lab Staff, EMS leaders and staff, Ancillary support.

6. © 2011 Health Management, Inc. Confidential. 6 Tennova Heart Institute Project Plan: » Set Project goals » Review and revise current state process and flowchart » Identify opportunities and wasted time » Team to meet weekly to review cases for areas of opportunity » Report out progress/opportunities weekly on STEMI boards and in staff meetings Project Improvements: » Opportunities and variables identified and eliminated » Code STEMI packet developed with clear roles and responsibilities during Code STEMI » Goals set and measures communicated with all priority staff » Early EMS field Activation

7. © 2011 Health Management, Inc. Confidential. 7 Tennova Heart Institute (examples)

8. © 2011 Health Management, Inc. Confidential. 8 Tennova Heart Institute (examples)

9. © 2011 Health Management, Inc. Confidential. 9 Tennova Heart Institute Early Activation  Early reperfusion in the catheterization laboratory has become the standard of care for acute ST segment- elevation MI (STEMI).  Important reductions in time to reperfusion are possible by activation of the catheterization laboratory by EMS from the scene. o Transmitting EKG as soon as possible o If unable to transmit, call ahead as soon as possible  Time is muscle, every second counts.

10. © 2011 Health Management, Inc. Confidential. 10 Tennova Heart Institute

11. © 2011 Health Management, Inc. Confidential. 11 Tennova Heart Institute Where we started Where we are

12. © 2011 Health Management, Inc. Confidential. 12 Tennova Heart Institute Next Steps: Develop in-house STEMI Team Straight to Cath Lab focus Education Drive down D2B times below national best practice percentile Collaboratively work with regional EMS teams to improve FMC to Balloon

13. © 2011 Health Management, Inc. Confidential. 13 Tennova Heart Institute Questions? Thank You!