1. The Health Roundtable Saving heart muscle by reducing delays to getting patients to the overnight regional catheter lab Presenter: Debby Hailstone Middlemore NZ Innovation Poster Session HRT1215 – Innovation Awards Sydney 11 th and 12 th Oct 2012 1 1-1c_HRT1215-Session_HAILSTONE_MIDDLEMORE_NZ

2. The Health Roundtable KEY PROBLEM STEMI Patients were identified as having a time critical need for treatment. International literature suggests that <90 minutes to primary PCI (Percutaneous Cardiac Intervention) is optimal. 2

3. The Health Roundtable AIM OF THIS INNOVATION  Aim: To ensure all eligible patients in the Auckland metropolitan area, who present with an acute ST elevation myocardial infarction (STEMI), receive primary Percutaneous Cardiac Intervention (PCI), within 90 mins, regardless of geographical location and time of day.  If a patient presents to Emergency Care after hours then they must be transferred to the regional cath lab for treatment as the hospital only provides this service during normal working hours Monday to Friday. 3

4. The Health Roundtable BASELINE DATA  24% Patients receive PCI within 90 minutes  Mean time to PCI 143 minutes 4

5. The Health Roundtable KEY CHANGES IMPLEMENTED  Assigned a co-coordinator in EC for all STEMI patients 24/7. It is their responsibility to ensure the pathway is followed.  Improved time to electrocardiogram (ECG)  Developed a flow chart for all STEMI patients, with focus on ‘after hours’.  We negotiated a process to ‘keep’ the original frontline ambulance that the patient arrived in after hours, in case there is a need for transfer to the regional cath lab. 5

6. The Health Roundtable OUTCOMES SO FAR  70% Patients receive PCI within 90 minutes  Mean time to PCI 83 minutes 6

7. The Health Roundtable LESSONS LEARNT  All the stakeholders had to be totally committed to achieving this goal, working together to align all aspects of project. However, the simplicity of the original idea did become complicated, due to working outside of our direct sphere of influence.  The project was at risk of not being completed within the implementation timeline. We had delays with third party information as to what their requirements actually were.  It is not always necessary to go for the technological solution as the seemingly simple ideas can have a very dramatic effect. 7