presenter disclosure information kevin daniel, rn, cen clinical data supervisor northside hospital...
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Presenter Disclosure Information
Kevin Daniel, RN, CEN
Clinical Data Supervisor Northside Hospital System
Metro Atlanta Mission Lifeline Quality & Data Co-Chair
Atlanta, Georgia
1
FINANCIAL DISCLOSURE:No relevant financial relationship exists
2
Objectives
• Demonstrate how participating in the ACTION registry improves ED/Hospital performance and patient outcomes by adhering to the AHA/ACC GWTG guidelines.
• Identify the inclusion and exclusion criteria of the ACTION
registry and Mission: Lifeline using data abstraction guidelines.
542 STEMI patients66% were Direct Presenters
34% were Transfers STEMI Referral to STEMI
Receiving center.
5%
Q2 2013
Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q2 2014 Q3 2014 Q42014 Q120150
50
100
150
200
250
300
350
400
172
267 269
336318
327
376359
99
134
156
188
215 220
185 183
TN Mission LifelineSTEMI Volume
Number of STEMI Patients Direct Presenters Linear (Number of STEMI Patients Direct Presenters)Number of STEMI Patients Transfers In Linear (Number of STEMI Patients Transfers In)
18 HospitalsTN Region
22 HospitalsTN Region
7 min
Q2 2013
Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q2 2014 Q3 2014 Q42014 Q1201555%
57%
59%
61%
63%
65%
67%
69%
71%
73%
72%
65%
64%
65%
67%
68%
65%
66%65% 65%
66% 66%
67% 67%
68% 68%
TN Mission LifelineFirst Medical Contact to PCI <= 90 Mins
FMC to PCI <= 90 mins-R4Q TN System FMC to PCI <= 90 mins-R4Q Nation
Pre-Hospital Activation is key
in reducing ED times &
Achieving FMC to Device in < 90 min
Longest PCI Time
Shortest PCI Time
75th Percentile
Median PCI Time
Average PCI Time
25th Percentile
Box and Whisker Plots
SystemMedian
Time 83mins
Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q2 2014 Q3 2014 Q42014 Q1201570.0
72.0
74.0
76.0
78.0
80.0
82.0
84.0
86.0
76.0
80.0
81.0
85.0
78.0
82.0
85.0
83.0
TN Mission LifelineMedian Time from First Medical Contact to Primary PCI
Direct Presenters Arriving by EMS
Median Time from First Medical Contact to Primary PCI (Mins) Linear (Median Time from First Medical Contact to Primary PCI (Mins))
heart.org/missionlifeline
Click Regional Report Glossary
Critical Process Timelines: First Medical Contact to Device for Non-Transfers Arriving via Ambulance (pages 5-6)Variable Definition Inclusion/Exclusion Criteria
First Medical Contact to Device Activation
(Direct Presentation EMS Only)
Transferred from Outside Facility = No
Means of Transport to First Facility = Ambulance
Median Time in Minutes (current quarter)
o First Medical Contact to Door(Arrival date/time) – (Pre-arrival 1st Medical Contact date/time)
o Door to Arrival at Cath Lab(Cath Lab Arrival date/time) – (Arrival date/time)
o Arrival at Cath Lab to Device Activation(First Device Activation date/time) – (Cath Lab Arrival date/time)
o First Medical Contact to Device Activation (National Median) (First Device Activation date/time) – (Pre-arrival 1st Medical Contact date/time)
All STEMI patients indicated for immediate primary PCI, excluding transfers in, patients with STEMI diagnosed on subsequent ECG, patients administered thrombolytics, documented non-system reason for delay in PCI, and FMC to PCI > 12 hours.
Patients may have missing or negative values for specific time intervals, which excludes them from ONLY the affected intervals. All other intervals with valid date/time data are included in the graph
Includes all direct presenters arriving via Ambulance only; Mobile ICU and Air transport are not included.
First Medical Contact to Device Activation
Transferred from Outside Facility = No
Means of Transport to First Facility = Ambulance
Distribution of Times in Minutes (current quarter)
First Medical Contact to Device Activation(First Device Activation date/time) – (Pre-arrival 1st Medical Contact date/time)
All STEMI patients indicated for immediate primary PCI, and had a reported first device activation date/time after first medical contact, excluding transfers-in, patients with STEMI diagnosed on subsequent ECG, patients administered thrombolytics, documented non- system reason for delay in PCI, and FMC to PCI time > 12 hours.
Includes all direct presenters arriving via Ambulance only; Mobile ICU and Air transport are not included.
Graph on Page 5
Regional Report
Graph on Page 6
Regional Report
EMS = Ambulance only, does not include Mobile ICU or Air transport POV = Personally Operated Vehicle (i.e., self/family
transport)FMC = First Medical Contact
- 7 -Confidential Information (ver
09/24/2013)
3110
3100
3201 3105 & 3106
4030
7101 & 7102 3201
7103 & 7104 7101 & 7102
7103 & 7104
3105 & 3106
7100 & 7109 & 8000 3110
4041 80207110
3100
3110
3100
7103 & 7104
4030 7100 & 7109 & 8000 31104041
80207110
3100
Pre-Hosp ECG obtained on
72% of STEMI pts arriving by EMS
Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q2 2014 Q3 2014 Q42014 Q120150%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
67%
53%57%
64% 65%
73%75%
72%
TN Mission LifelineFirst ECG Obtained Pre Hospital
EMS Arrival
First ECG Obtained Pre Hospital (EMS Arr.) Linear (First ECG Obtained Pre Hospital (EMS Arr.))
26% of STEMI pts who walk in to ED’s are waiting for more than 10 minutes for
their first ECG
26% of STEMI pts who walk in to ED’s are waiting for more than 10 minutes for
their first ECG
Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q2 2014 Q3 2014 Q42014 Q1201565%
70%
75%
80%
85%
90%
87%
79%
81%
75%76%
74%73%
74%
TN Mission LifelineECG w/in 10 mins of Arrival Direct Presentation by POV
ECG w/in 10 mins of Arrival Direct Presentation by POV Linear (ECG w/in 10 mins of Arrival Direct Presentation by POV)
Recommended DIDO 30 min
If expected delays D2B >120 mins give Lytics
Median Time 125
mins
Median Time
• Prehospital activation is the most important thing that EMS can do to increase the chance that a STEMI patient will achieve FMC to device in
< 90 mins.• EMS must work to increase the rate of obtaining
field ECGs in patients with suspected STEMI.• Successful prehospital activation depends on
calling the ED as soon as STEMI is recognized on the field ECG. Transmission of the field ECG is secondary and should not delay a phone call to alert the ED of a “code STEMI”.
Take home points: Direct presentation by EMS
• If there is a nearby STEMI receiving center (24/7 PCI center), EMS should bypass referral centers and go directly to receiving centers.
• Centers that transfer STEMI patients and/or receive these transfer patients must work together to reduce Door-in-door-out time and reduce patient transport times to the STEMI receiving facility.
• If anticipated Door-to-Door-to-Device time > 120 minutes, give fibrinolytic at the first hospital.
Take home points: Transfers
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