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AHA Dallas Caruth Initiative Dallas Stakeholder Committee Minutes December 1, 2011

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American Heart Association Dallas Office 8200 Brookriver Drive, Classroom A

Conference Call Number 866-506-5191, Participant Pass code 335721# www.heart.org/caruth

Co-Chairs: Ray Fowler and Michael Isaac Staff Liaison: Leilani Stuart and Russell Griffin

Organizations Attendees

Addison Fire Department Chris Kellen

Baylor Heart and Vascular Hospital Andres Sisneros

Baylor Heart and Vascular Hospital Art Signo

Baylor Heart and Vascular Hospital Nancy Vish

Baylor Medical Center at Irving Barry Allen

Baylor Medical Center at Irving John Stricklin

Baylor University Medical Center Kristine Powell

Cedar Hill Fire Department Kevin Cunningham

Carrollton Fire Department Steve Heath

Dallas Fire Rescue Tami Kayea

Dallas Fire Rescue Chris Chiara

Dallas Regional Medical Center Daniel Cervantez (teleconference)

Dallas Medical Center Amy Ferguson (teleconference)

DeSoto Fire Rescue James Bell

Doctors Hospital of Dallas Bob Hillert

Duncanville Fire Department Sam Rohde

Farmers Branch Fire Department Stephen Bock

FWESC Deborah Krause

Garland Fire Department Garrett Evans (teleconference)

Grand Prairie Fire Department J.D. Yates

Highland Park DPS Janet Sandman

Irving Fire Department Steve Deutsch

Lancaster Fire Department Laura Hillary

Las Colinas Medical Center Michael Lopez

Medical City Dallas Hospital Jennifer Ledbetter

Mesquite Fire Department Bob Muse (teleconference)

Methodist Charlton Medical Center Michael Merritt

Methodist Dallas Medical Center Christine Walker

Methodist Dallas Medical Center/EMS BioCare Melissa Sherman

Methodist Richardson Medical Center Tarah Grooms (teleconference)

Parkland Hospital Thomas Tierney

Richardson Fire Department Curtis Poovey

Rowlett Fire Rescue Ron Simmons

Sunnyvale Fire Rescue Ashley Howard

Texas Health Presbyterian Dallas Debby Rush

Texas Health Presbyterian Dallas Mark Till

Texas Health Presbyterian Dallas Paula Spencer

http://www.heart.org/caruth


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Texas Regional Medical Center Sunnyvale Michael Adelhardt

TLC Chris Weinzapfel

UT Health Science Center Houston Jamie Emert

UT Southwestern Medical Center Ray Fowler

UT Southwestern Medical Center Richard King

UT Southwestern Medical Center Sarah Gualano

American Heart Association Diana Ramirez

American Heart Association Leilani Stuart

American Heart Association Russell Griffin

American Heart Association Wendy Segrest

7:00 am Continental Breakfast

1. 7:30 am Welcome & Introductions Ray Fowler

Exhibit 1A Stakeholder Committee Voting Member Roster Exhibit 1B DSC Minutes from September 1, 2011 meeting Background: Michael Taylor has stepped down as the previous Dallas Stakeholder Committee Co-Chair and has recently moved out of the state. Michael Isaac, an interventional cardiologist from Medical City, has graciously accepted the position as co-chair of the Dallas Stakeholder Committee. Goals:

This group represents the establishment of a formal oversight committee for this initiative in Dallas County to build a coordinated regional AMI system of care.

Implement the grant-funded initiative, including the goals, participation requirements, educational and data analysis opportunities, and available honoraria for participating hospitals and EMS agencies.

Action: Introduction of Michael Isaac as the new Dallas Stakeholder Committee Co-Chair. Edit and approve September 1, 2011 meeting minutes. Minutes: Minutes approved for September 2, 2011 meeting

2. 7:40 am Committee Structure and Documentation Ray Fowler Exhibit 2A Stakeholder Commission Statement

Exhibit 2B Stakeholder Committee Approved Recommendations Exhibit 2C AHA Ethics policy Exhibit 2D AHA Conflict of Interest policy Background: Dallas Stakeholder Committee and Subcommittee Commission documents detail


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respective goals, member commitment and responsibilities. Conflict of Interest (COI) and Ethics policy to be reviewed. Committee approved recommendations are provided in Exhibit 2B for historical information. Committee members are asked to read exhibits prior to meeting attendance. Action: Information only. Minutes: Information Only

3. 7:45 am Data Update Jamie Emert Exhibit 3A Caruth Overview – to be attached at a later date

Background: Data collection and analysis is a critical component of this initiative. Data from EMS and hospitals has been analyzed for three full quarters from the initiative (October 1, 2010 – June 30, 2011) and the results and recommendations will be presented by colleagues at University of Texas Health Science Center in Houston. Action:

Review most recent data results.

Review recommendations to improve data submission and quality.

Stakeholder representative responsible to share data with their internal organization.

Minutes:

Suggestion: Slide 20 of presentation, for public awareness, state that it’s better to contact EMS than to drive yourself to the hospital

Suggestion: Slide 23, change longest distance travelled to show the zip code of where the patient had the event, not their mailing address zip (i.e. patients that may have been picked up from the airport that are from out of town)

4. 8:10 am Quality Improvement Subcommittee Bob Hillert & Tom Tierney Exhibit 4A Subcommittee Report: Quality Improvement

Exhibit 4B Award Notice for Quarter 2, 2011 Outstanding System Performer Background: Subcommittee members met and created recommendations for this committee. An update on the Quarter 2, 2011 Outstanding System Performer award will be presented. Action:

Co-Chairs to present the Subcommittee recommendations for Stakeholder review and approval.

Stakeholder representative responsible to share quality improvement recommendations with their internal organization.


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Minutes:

QI Report has two recommendations as voting items: 1. Subcommittee proposes that the winner of the quarterly award for

Outstanding Regional System Performer be awarded to Medical City Hospital and Dallas-Fire Rescue for a total EMS time of 38 minutes, D2B time of 28 minutes and SOAR time of 89 minutes as detailed in Exhibit 4B. – approved as is

2. Subcommittee proposes these additional analyses be added to quarterly

data report from UTHSCH: – approved as is a) EMS D2B and SOAR times vs. walk-in D2B and SOAR times b) Age analysis on deceased patients c) Median D2B time of top 10 walk-in patients d) Median SOAR times be broken down by time of day e) Median SOAR times of male vs. female patients f) Walk-in vs. EMS% for N-STEMI patients g) History and risk factors of deceased patients h) % STEMI patients with field activation i) Analyze D2B cases that are >90 minutes and evaluate if they are

occurring in hospitals with <10 STEMI patients/quarter or >10 STEMI patients/quarter and if they arrived by EMS

j) Sort D2B rankings into two lists: volume <10 and volume >10

5. 8:20 am Education Subcommittee Karen Pickard & Chris Weinzapfel Exhibit 5A Subcommittee Report: Education

Exhibit 5B Education Plan and Timeline Exhibit 5C Education Implementation Update Background: Subcommittee members met and created recommendations for this committee. Educators from the different agencies/hospitals have been actively implementing the curriculum and education plan that was approved at the September Dallas Stakeholder meeting. Discussion will include progress of the current plan, supplemental forms of STEMI education, challenges and future threats. Action:

C0-Chairs to present a summary review of progress on the Caruth education implementation, including future challenges.

Stakeholder representative to review and edit or approve the presented Subcommittee recommendations.

Stakeholder representative responsible to share education recommendations with their internal organization.

Minutes:

Education Report has one recommendation as a voting item:


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1. The Education Subcommittee Co-Chairs will provide an update on the status of the distribution of the Caruth education plan as presented in Exhibits 5B and 5C. – information only

2. Subcommittee proposes a 90% Rule be applied to those EMS agencies

that declined the employee gift cards. A recommendation has been made to add $10.00 to the organization stipend to total $30.00. Subcommittee proposes 90% of all certified personnel must complete the EMS STEMI workbooks to be eligible for the $30.00/employee stipend and funding must be earmarked for education. – approved as is

6. 8:30 am EMS Advisory Subcommittee Kevin Cunningham & Craig White Exhibit 6A Subcommittee Report: EMS Advisory

Background: Subcommittee members have deferred meeting as an EMS Advisory Subcommittee and instead have been participating in Protocols and Education subcommittee meetings. Action: Information Only. Minutes: Information Only

7. 8:35 am Protocols Subcommittee Mark Till & Chris Chiara Exhibit 7A Subcommittee Report: Protocols

Exhibit 7B Standardized Regional Protocol Update Background: Subcommittee members met and created recommendations for this committee. The deadline to submit updated/revised protocols for a standardized regional protocol set across Dallas County was November 1, 2011. Action:

Stakeholder representative to review and edit or approve the Subcommittee recommendations.

Stakeholder representative responsible to share protocol recommendations with their internal organization.

Minutes:

Protocols Report has two recommendations as voting items: 1. Subcommittee proposes a feedback loop be utilized between all EMS

agencies and hospitals to include the following information within 48 hours of patient arrival:

a. EMS provider reports the following information to the hospital:


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i. Why hospital did not activate cath lab after EMS field activation

ii. Why hospital did not keep patient hooked up to EMS monitor or EMS stretcher when applicable

b. Hospital reports the following information to the EMS agency: i. Why hospital did not active from the field or cancelled

“Code STEMI” ii. Why hospital did not keep patient on the EMS monitor or

EMS stretcher when applicable iii. Any pertinent information related to patient outcome and

care during hospital stay o Dallas Stakeholder Committee did not approve

Suggested to create a form to provide feedback after a cancelled “Code STEMI” or over activation

Suggested further clarification from Protocol Subcommittee on workflow issues related to a regionalized feedback loop

2. Subcommittee reviewed Exhibit 7B, the protocols submitted at the

November 8th meeting. Some organizations have not yet submitted documentation of the protocol/guideline implementation within their organization and some are still in the process of getting approval for implementation. 14/15 hospitals and 21/24 EMS agencies have submitted implemented regionalized standardized protocols to date. – information only

8. 8:45 am Conference Planning Subcommittee Tami Kayea & Jennifer Ledbetter Exhibit 8A Subcommittee Report: Conference Planning

Background: Subcommittee members met and created recommendations for this committee. AHA staff to continue to work with conference staff at AHA National Center to identify venues and dates for the 2012 conference. Action:

Updates on venue and date will be provided. Minutes: Information Only Suggested to get EMS tech vendors on a panel discussion at conference to answer specific questions as to how or why they can get ECG transmission equipment to work together (i.e. Zoll tablet running with a Visio monitor)

9. 8:50 New Business Ray Fowler Stakeholder representatives are asked to bring forward any new issues or business to

address within this initiative.


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Minutes:

AHA staff is working on a sustainability model for the grant

AHA Dallas will be requesting a grant from Communities Foundation of Texas to fund a community/public awareness campaign to kick off Spring of 2013

10. 8:55 Review Action Steps Russell Griffin & Leilani Stuart Next meeting date is March 1, 2011.

Refer to web site for additional information and meeting dates. Action: Summarize a list of action steps from today’s meeting in preparation for the next Dallas Stakeholder Committee meeting. Minutes: Our next meeting is scheduled for March 1, 2011

11. 9:00 Adjourn Adjourned 9:00 am

Ray Fowler

AHA Dallas Caruth Inititative Stakeholders Voting Member Roster December 2011

Addison Fire Department Chris Kellen

Baylor Heart and Vascular Hospital Nancy Vish

Baylor Medical Center at Garland Janice Walker

Baylor Medical Center at Irving Barry Allen

CareFlite Jan Cody

Carrollton Fire Department Steve Heath

Cedar Hill Fire Department Kevin Cunningham

Coppell Fire Department Gregg Loyd

Dallas Fire Rescue Tami Kayea

Dallas Medical Center Amy Ferguson

Dallas Regional Medical Center Daniel Cervantez

DeSoto Fire Rescue James Bell

Doctors Hospital at White Rock Lake Bob Hillert

Duncanville Fire Department Sam Rohde

Farmers Branch Fire Department Stephen Bock

Garland Fire Department Garrett Evans

Glenn Heights Fire Department Jason Cates

Grand Prairie Fire Department Lt. J.D. Yates

Highland Park DPS Janet Sandman

Hutchins Fire Department Mike Telford

Irving Fire Department Steve Deutsch

Lancaster Fire Department Laura Hillary

AHA Dallas Caruth Inititative Stakeholders Voting Member Roster December 2011

Las Colinas Medical Center Mike Lopez

Medical City Dallas Hospital Jennifer Ledbetter

Mesquite Fire Department Bobby Muse

Methodist Charlton Medical Center Michael Merritt

Methodist Dallas Medical Center Christine Walker

Methodist Richardson Medical Center Tarah Grooms

Parkland Hospital Kelly Heathman

Richardson Fire Department Curtis Poovey

Rowlett Fire Rescue Ron Simmons

Sachse Fire Department Rick Coleman

Sunnyvale Fire Rescue Ashley Howard

Texas Health Presbyterian Dallas Paula Spencer

Texas Regional Medical Center Sunnyvale Mike Adelhardt

TLC Darryl Quigley

University Park Fire Department Rusty Massey

UT Southwestern Medical Center Sarah Gualano

Wilmer Fire Department Mark Hamilton

Jim Langabeer, PhD, EMT-b Jami DelliFraine, PhD Jamie Emert, BS UT Center for Emergency Research The University of Texas Health Science Center www.sph.uth.tmc.edu/emergency

v2 Updated Nov 10 2011

Dallas County – STEMI System of Care Q2 2011 Performance Metrics and Quarterly Update

http://www.sph.uth.tmc.edu/emergency

Q2 Highlights

2

•STEMI patient volumes were up 27%, while

mortality rates decreased slightly

•Virtually no change in patient demographics

•We matched 100% of primary PCI, non-transfer

cases between hospital and EMS records

•Median SOAR times decreased by 4% from last

quarter

•D2B times decreased by 16%

•EMS records were significantly more complete this

quarter, for 3 reasons:

•Changes in DB procedures from Biotel (thank

you Rick)

•More thorough follow-up protocol direct to each

agency (thank you Russ)

•Better use of Aux3 records in NCDR by

hospitals (thank you Leilani)

3

A Refresher of Dallas PCI Hospitals & EMS Agency Network

Q2 2011 Patient Volumes

4

•668 cases in total for Dallas County

•15 participating hospitals

•24 EMS agencies

•234 STEMIs were noted

•434 N-STEMI

•155 complete, primary PCI, non-transfer

STEMI cases

Patient Demographics

5

Demographics* Q4 2010 Q1 2011 Q2 2011

Average Age (yrs) 64 63 63

Male 65% 61% 67%

% Caucasian 71% 75% 73%

% Asian 2.4% 2.4% 2.5%

% Black 20% 18% 22%

% Hispanic Origin (of any race)

14% 12% 14%

* Figures rounded for presentation purposes

6

Density Map - Where Did our Patients Come From

No Major Shift from Previous Quarter Legend:

# of Patients

STEMI & Total Patient Volumes

7

141 124 135 137

109

157 137 146 151

67 68

68 64

52

68

68

89 77

0

50

100

150

200

250

STEMI

N-STEMI

STEMI Key Outcome Metrics 1

8

1 non-transfer, STEMI, primary PCI only

Metrics Q2 Trend

SOAR 173

D2B 65

FMC2B 83

E2B 69

Cath Lab time 19

Total EMS

Time

31

Q4

‘10

Q1

‘11

Q2

‘11

Summary by Hospital (Q2 2011)

9

1 Complete qualifying cases only (STEMI, Non-transfer, primary PCI only)

Hospital

Qualifying1

STEMI in

our

Analyses

(primary,

NT)

Qualifying1

STEMI % of

Total Patients

SOAR

(median)

D2B

(median)

Rank by

D2B Times

1 >10 27% 161 99 14

2 <10 43% 189 60 7

3 <10 10% 382 58.5 6

4 >10 23% 153 53 4

5 <10 0% -

6 >10 37% 135 66 10

7 <10 13% 452 58 5

8 <10 21% 229 73 11

9 >10 56% 224 46 2

10 <10 15% 220 79.5 13

11 <10 20% 191 78 12

12 >10 57% 161 44 1

13 <10 13% 236 65 9

14 >10 30% 178 62.5 8

15 <10 25% 106 50 3

Totals 155 28% 164 83%

SOAR Analysis – Q2 2011 Median time in Minutes

10

Onset to First Med Contact

90

FMC to ECG 18

ECG to Door 4

ECG to Cath 50

Cath to Device 19

0

50

100

150

200

173

SOAR by Hospital Median Times

11

0

50

100

150

200

250

300

350

400

450

500

1 2 3 4 6 7 8 9 10 11 12 13 14 15 overall

Cath to Device

ECG to Cath

Door to ECG

FMC to Door

Onset to FMC H

5 N

O Q

UA

LIF

IED

ST

EM

I

30

40

50

60

70

80

90

100

110

120

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Median Mean

H5

N

O Q

UA

LIF

IED

ST

EM

I

D2B by Hospital STEMI, Primary PCI, Non-Transfer

Median

Hospital ID # (Blinded)

Target

12

n>10 n<10 n<10 n>10 n<10 n>10 n<10 n<10 n<10 n<10 n<10 n>10 n<10 n>10

n<10

79% of Cases < 90 Minute D2B % of Cases in Each time category

13

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

<60 Mins 61-90 Mins

91-120 Mins >2 hours

45%

34%

10% 11%

STEMI, Non-Transfer, Primary PCI Only

STEMI Hospital Outcomes

14

•The shortest D2B time was 20 Minutes

•The shortest SOAR time was 44 Minutes

•Average length of stay for all STEMI (non-

transfer, primary PCI) patients was 3.6 days

(down from 4.5)

•We had 12 deaths in the STEMI population

(5%) and 25 deaths overall (3.7%)

EMS Data – Q2 2011

15

EMS Stats Q4 2010 Q1 2011 Q2 2011

Median total EMS

time (unit notified to

hospital arrival) for

STEMI patients

- 29.5 minutes 31.0

Patients Arriving by

EMS

42% 41% 40%

(51% STEMI)

% of Incident Run

#’s entered by

Hospitals

40% 58% 85%

EMS Matches 10% 50% 100%

EMS Performance Times Median Times, STEMI Only

16

9 5 6 5 4 4 6 2 7

2 1 3 12

19

16 19 17

24

13

26

22 18

16

4

16

11

52

30 33

25

49

24

42 42 38

27

10

32 31

0

10

20

30

40

50

60

Dispatch to Arrival EMS Onscene Time Total EMS Time

Other Statistics

First 3 Full Quarters

17

STEMI Admissions in Dallas Tuesday & Thursday’s Higher Volume

(weekends drop off)

Monday 12%

Tuesday 21%

Wednesday 15% Thursday

20%

Friday 12%

Saturday 10%

Sunday 10%

18

D2b Varies Significantly by Day of Arrival

(but SOAR time does not)

60

65

70

75

80

85

+ Both means and medians statistically significantly different (ANOVA F=3.78, p<.01; KW=20.7, p<.01);

Tests for Std. Dev also significant

19

Impact on D2B When Cath Lab is Activated by EMS

73

57

0 10 20 30 40 50 60 70 80

No

Yes

D2b Minutes (median)

Ca

th L

ab

Ac

tiva

tio

n b

y E

MS

* Notes: Primary PCI, non-transfer, STEMI only

* EMS Activation taken from NCDR form Aux3 field

+ Both medians and means statistically significantly different (Wilcox W=4791, p<.0001; F=40.5, p<.001)

20

D2B Significantly Different by Time of Day

# of Total STEMI Cases by time of day presenting

118, 22%

269, 49%

160, 29%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Evening (5 pm to midnight)

Day (8 am to 5 pm)

Early Morning (Midnight to 8 am)

D2B = 77

D2B = 64

D2B = 79

+ Medians statistically significant (Wilcox W=2487, p<.0001; F=40.5, p<.001; Moods=23.066, p<.0001)

21

Time of Day Might Matter

• There is a large, but non-significant difference between mortality rates for three categories of time (8 am to 5 pm; 5 pm to midnight; midnight to 8 am) – Currently significant @ p<.10

• Patients presenting from 12 am to 8 am are 2.2 times more likely to die (non-adjusted) than 8 am to 5 pm

• More cases will impact the significance so we will continue to monitor this

22

Distances Traveled in Dallas County AMI

• Geo-coded Euclidian distances between patient and provider

• Average distance traveled: – 5.97 (ALL patients)

– 6.69 (STEMI only)

• Of STEMI, – Those driving/self = 7.6 miles

– EMS transport = 6.12

• Range between 0 miles and 1400 miles (upper/lower quartiles between 2.7 – 17.2 miles)

• However, no significant differences in FMC2B between the two groups

• No statistically significant differences in mortality for EMS arrivals vs Self

23

Top 30 Best D2B

(EMS=22 of 30 top performers)

24

Top 10 Non-EMS Arrivals

(Self-Transport), sorted by D2B

25

Deceased Patient Analysis

26

Notes:

•These 12 patients represent deaths in the STEMI population only

•Patients ranged from 41 to 92 years

•Only 2 patients were > 80 years

•For All Deceased Patients (stemi/non) the average age was 73, with a similar distribution to

above

AHA Dallas Caruth Initiative Subcommittee Report: Quality Improvement December 1, 2011

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Subcommittee Co-Chairs: Bob Hillert and Tom Tierney Quality Improvement Subcommittee Goals

1. Assess internal QI process and frequency in participating organizations

2. Assess how the region or county can create a regular and sustainable QI process to measure system performance

Identify barriers to data collection and reporting in participating organizations (EMS)

Identify ways to help capture and measure “system” level items like reperfusion to recognition (R2R) or symptom onset through arterial reperfusion (SOAR).

Quality Improvement Subcommittee Recommendations Stakeholder Committee vote needed to approve or amend

1. Subcommittee proposes that the winner of the quarterly award for Outstanding Regional System Performer be awarded to Medical City Hospital and Dallas-Fire Rescue for a total EMS time of 38 minutes, D2B time of 28 minutes and SOAR time of 89 minutes as detailed in Exhibit 4B.

2. Subcommittee proposes these additional analyses be added to quarterly data report

from UTHSCH: a) EMS D2B and SOAR times vs. walk-in D2B and SOAR times b) Age analysis on deceased patients c) Median D2B time of top 10 walk-in patients d) Median SOAR times be broken down by time of day e) Median SOAR times of male vs. female patients f) Walk-in vs. EMS% for N-STEMI patients g) History and risk factors of deceased patients h) % STEMI patients with field activation i) Analyze D2B cases that are >90 minutes and evaluate if they are occurring

in hospitals with <10 STEMI patients/quarter or >10 STEMI patients/quarter and if they arrived by EMS

j) Sort D2B rankings into two lists: volume <10 and volume >10

Outstanding Regional System Performer AHA Dallas Caruth STEMI Initiative

2nd Quarter - 2011

Award Presentation - November 28, 2011 9-10 am

Medical City Hospital

City Hall E Tower

7777 Forest Lane Dallas, Texas 75230

Introduction: Wendy Segrest

Vice President of Quality and Systems Improvement

American Heart Association - SouthWest Affiliate

Award Presentation: Thomas Tierney

Operations Manager - Biotel Parkland Health and Hospital System

Co-Chair - QI Subcommittee - Dallas Caruth Initiative

Award Recipients:

Dallas Fire-Rescue

Tami Kayea - Section Chief - EMS

Medical City Dallas Hospital Jennifer Ledbetter - Director of Cardiovascular Services

AHA Dallas Caruth Initiative Subcommittee Report: Education December 1, 2011

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Subcommittee Co-Chairs: Karen Pickard and Chris Weinzapfel Education Subcommittee Goals

1. Professional Assess AMI emergency care knowledge gaps Develop an education curriculum – content and structure a. Evaluate educational outcomes

2. Public a. Identify a public awareness campaign strategy and timeline for promotion of

“911” for heart attack symptoms via third party evaluation

Education Subcommittee Recommendations Stakeholder Committee vote needed to approve or amend

1. The Education Subcommittee Co-Chairs will provide an update on the status of the distribution of the Caruth education plan as presented in Exhibits 5B and 5C.

2. Subcommittee proposes a 90% Rule be applied to those EMS agencies that declined

the employee gift cards. A recommendation has been made to add $10.00 to the

organization stipend to total $30.00. Subcommittee proposes 90% of all certified

personnel must complete the EMS STEMI workbooks to be eligible for the

$30.00/employee stipend and funding must be earmarked for education.

AHA Dallas Caruth Initiative Education Plan and Timeline for Curriculum Distribution August 2011

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Education Subcommittee Goals

Professional o Assess AMI emergency care knowledge gaps o Develop an education curriculum – content and structure o Evaluate educational outcomes

Public o Identify a public awareness campaign strategy and timeline for promotion of

“911” for heart attack symptoms via third party evaluation Professional Education Assessment

Needs Assessment Survey o Distributed for completion March – June 2011

EMS – Paramedic – EMT-Basic Hospital – ED Tech – ED Nurse – ED Physician – Cath Lab Tech – Cath Lab

Nurse – House Supervisor – Interventional Cardiologist

Results o Survey’s closed for submission July 1st, 2011

EMS – 897 individual completions Hospital – 571 individual completions

Conclusion o Questions included assessment of STEMI processes and general clinical

assessment of key 12-Lead ECG components. o Evidence within survey shows greatest educational gap is process education and

familiarization with interagency coordination. Professional Education Content

STEMI Education workbooks were developed based on the criteria found within the survey which address essential STEMI processes.

Education content focus: o Early recognition of ACS patients o Early 12-Lead ECG to identify STEMI o Early activation of receiving hospital cardiac cath labs o Rapid transport of STEMI patients to a proper receiving facility o EMS and hospital coordination to reduce treatment delays


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Delivery

EMS STEMI Workbooks o EMS and Hospital versions have been created o Will be distributed to EMS and Hospital educators for distribution o Content requires approximately 15-20 minutes to complete o Student completes test to verify course completion

Education Participation Incentive

Participation incentive to help offset staff costs for workbook implementation

Student incentive to help generate interest for thorough distribution

Evaluation

Post-test completed by student at time of workbook completion

Needs assessment will be redistributed January – March 2012

Differences between initial and post-intervention assessment will be assessed Budget

Education Budget Qty Unit Price $ 220,000

Key Educational Components Estimated

Educational Booklet (3,300 EMS - 2,300 Hospital) 6000 $4.00 $ 24,000

$10 Gift Card to every person that completes Workbook 6000 $10.00 $ 60,000

$20 stipend completed Sheet EMS/Hosp submits to AHA 6000 $20.00 $ 120,000

Enduring Materials

Pens 4000 $0.58 $ 2,320

Mouse Pads 1000 $1.85 $ 1,850

Cards 4000 $1.00 $ 4,000

Posters 500 $1.00 $ 500

Primary Education Subtotal $ 212,670

Remaining Budget for Supplemental Training $ 7,330


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Timeline June 30, 2011

Needs assessment completed on knowledge gaps with hospitals and EMS staff

Surveys reviewed for content and educational gaps identified August 10, 2011

Education content presented to Education subcommittee

Recommended delivery mode and implementation timeline prepared for presentation to Stakeholder Committee

Evaluation plan and timeline prepared for presentation to Stakeholder Committee

September 1, 2011

Stakeholder approval from Education Subcommittee recommendations September 5-9th, 2011

STEMI workbooks delivered

Gift cards for staff delivered to EMS agency/Hospital representative

November 15, 2011

STEMI workbooks completed

Post-tests submitted for analysis and eligibility for hospital stipend

Hospital stipend payments processed

December 31, 2011

100% of contracted EMS providers and hospitals complete scientifically-based American Heart Association EMS and hospital training curriculum

January 1, 2012

Post survey administered to all EMS and Hospital employees April 1, 2012

Survey results reviewed and reported

Evaluation of results

Education Update

• STEMI Workbook Distribution – EMS - 3,967

– Hospital – 2,204

• Refused Gift Cards – EMS – 2,385

– Hospital - 70

• 90% Rule – $30.00/employee if training exceeds 90% of all

certified personnel

– Funding must be earmarked for education

Education Update

• Bob Page Multi-lead Medic Sessions – November 10th, 2011 – 90 attendees

– January 10th, 2012 – AHA Dallas Office

• Continuous Education – Ensuring broad implementation while ensuring

constant messaging.

• Evaluation – Survey in Spring of 2012

– Other opportunities for STEMI education

AHA Dallas Caruth Initiative Subcommittee Report: EMS Advisory December 1, 2011

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Subcommittee Co-Chairs: Kevin Cunningham and Craig White EMS Advisory Subcommittee Goals Identify equipment requirements for successful transmission of 12-lead ECG on

suspected AMI patients for all EMS Agencies - completed

Identify requirements for data submission to be analyzed by third party - completed

Identify requirements for hospitals to obtain transmission of 12-lead ECG from EMS Agencies - completed

4. Identify additional equipment and training requirements for EMS Agencies to

optimally treat AMI patients

EMS Advisory Subcommittee Recommendations Stakeholder Committee no vote needed

1. Report Only: Continue to evaluate the implementation of ECG transmission equipment and evaluate future needs in Dallas County.

AHA Dallas Caruth Initiative Subcommittee Report: Protocols December 1, 2011

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Subcommittee Co-Chairs: Chris Chiara and Mark Till Protocol Subcommittee Goals: Assess how many of the 39 participating organizations have existing AMI protocols Identify process to review individual organization and system needs for a

standardized regional assessment, treatment and transport protocol set Identify elements required for a standardized regional protocol set Identify process to review different protocols and start assimilating 5. Identify process to evaluate implementation of and outcomes of new standardized

regional protocol set Protocol Subcommittee Recommendations Stakeholder Committee vote needed to amend or approve –

1. Subcommittee proposes a feedback loop be utilized between all EMS agencies and hospitals to include the following information within 48 hours of patient arrival:

a. EMS provider reports the following information to the hospital: i. Why hospital did not activate cath lab after EMS field activation

ii. Why hospital did not keep patient hooked up to EMS monitor or EMS stretcher when applicable

b. Hospitals reports the following information to the EMS agency: i. Why hospital did not active from the field or cancelled “Code STEMI”

ii. Why hospital did not keep patient on the EMS monitor or EMS stretcher when applicable

iii. Any pertinent information related to patient outcome and care during hospital stay

2. Subcommittee reviewed the submitted protocols at the November 8th meeting.

Some organizations have not yet submitted and some organizations are still in the process of getting approval for submission. 14/15 hospitals have submitted protocols and 21/24 EMS agencies have submitted protocols. Exhibit 7B details the subcommittee’s requests/recommendations to date.

Protocol Update

• Protocols not received to date: – Methodist Dallas, Wilmer, Glenn Heights, Hutchins

– Subcommittee proposes follow-up

• Committee requests/recommends changes to protocols that are incongruent with regionally approved set: – UTSW, Parkland, Baylor Heart and Vascular, Baylor

Irving, Medical City, Metrocrest, Grand Prairie

– Subcommittee proposes follow-up

AHA Dallas Caruth Initiative Subcommittee Report: Conference Planning December 1, 2011

Page 1 of 1

Subcommittee Co-Chairs: Tami Kayea and Jennifer Ledbetter Conference Planning Subcommittee Goals

1. Plan the content and schedule of a regional professional education conference for June 2011

2. Plan the content and schedule of a regional professional education conference for June 2012

3. Format the regional professional education conference on the latest STEMI/NSTEMI treatment and system initiatives

Conference Planning Subcommittee Updates

1. Planning for 2012 Conference started August 2011

2. Medical Directors recruited

3. Goal to increase 2012 conference exhibitors

4. Goal to recruit additional volunteers to plan the 2012 Conference

5. Dates under consideration for the 2012 Conference:

a. May 31, June 1

b. June 7, 8

Conference Planning Subcommittee Recommendations Stakeholder Committee vote needed to amend or approve

1. None at this time – Information Only

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