Regional Showcase West Tennessee. Speakers: John Baker M.D./Emily Garner RN Presentation: Regional...
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Transcript of Regional Showcase West Tennessee. Speakers: John Baker M.D./Emily Garner RN Presentation: Regional...
Regional ShowcaseWest Tennessee
Speakers: John Baker M.D./Emily Garner RNPresentation: Regional Showcase – West Tennessee
Presenter Disclosure Presenter Disclosure InformationInformation
•FINANCIAL DISCLOSURE:No relevant financial relationship exists
Jackson Madison County General Jackson Madison County General HospitalHospital
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.
WTH Service Area2014 Population
Primary Service Area
Madison County 102,515Gibson County 49,467Carroll County 30,095Henderson County 28,390Hardeman County 30,607Crockett County 15,494Chester County 17,179Haywood County 19,851Subtotal 293,598
Secondary Service Area
McNairy County 26,604Hardin County 27,236Decatur County 11,519Henry County 33,002Weakley County 34,045Benton County 16,833Dyer County 39,450Obion County 32,935Lauderdale County 28,918Lake County 7,391Subtotal 257,933
Total Population 551,531
Primary Service Area
Secondary Service Area
.8
.9 .10
.7 .2.4
.1.5
.6
.13.12
.11.3
LAKE OBIONWEAKLEY
HENRY
STEWART
DYER
GIBSON HUMPHREYS
LAUDERDALE
CROCKETT
MADISON
HENDERSON
PERRY
TIPTON
HAYWOOD
CHESTER
HARDINMCNAIRY
HARDEMAN
FAYETTESHELBY
HOUSTON
DECATUR
BENTONCARROLL
WAYNE
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West Tennessee SystemWest 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)
.
Measure Initial State
Door to EKG Completion 21% of all cases = 5 minutes50% of STEMIs = 5 minutes
Door to STEMI Diagnosis 70% of cases = 10 minutes83% of STEMIs = 10 minutes
Door to Cath Lab Activation 74% of cases = 15 minutes
Door to Arrival CCL Team 83% of cases > 40 minutes
Door to Device Deployment (Door to Balloon Time)
35% of cases ≤ 90 minutes
JMCGH STEMI Mortality Rate 25%
Initial StateInitial State
Target StateTarget State
Chest Pain patient arrives
ECGdone STEMI?
No
Yes
EDActivatesCCL
CCL Member 1arrives
PatientMoved toCCL with2 ED Nurses
CCL Member 2arrives
Chest Pain Unit for obs
PatientPrepped
PatientTransferred FromStretcher to table
CCL Member 3 & Cardiologistarrives
Arterial Access By MD
Balloon Inflated
ED – ECGGoal: 10 min
ECG - CCLGoal: 45 min
CCL - BalloonGoal: 35 min
New Process for STEMI Patients
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Where We Started Where We Started Q32011Q32011
ChallengesChallenges
• 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
SuccessesSuccesses
Education to all West TN Hospitals and EMS Systems
oGuidelines/TimesoEarly Recognition/TrainingoEarly Activation of TransportoEKG Transmission/Fax
Development of Co-Management Contract with Cardiologist
Annual STEMI 12 Lead EKG Training oProgram with Med Center EMS, Air Evac Lifeteam
SuccessesSuccesses
Quarterly Regional STEMI/Chest Pain Center Accr. Meetings
oWeb/Conference AvailableoMonthly Internal Meetings
Network Visits – Building Relationships is KEY!
Auto Accept/One-Call Policy
Resources Conference Calls for TransfersCommunity STEMI DrillsFeedback Data10-10-10 PlanSTEMI Treatment Zones/Map
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SuccessesSuccesses
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=dQH8LfbzmtM
Source: NCDR Registry – PCI - Metric #16Owner: W.TN Heart & Vascular Center
50th = 59.2mins
90th = 47mins
Source: NCDR Registry – Action - Metric #6Owner: W.TN Heart & Vascular Center
50th = 107mins
90th = 80mins
Source: NCDR Registry – PCI - Metric #18Owner: W.TN Heart & Vascular Center
50th = 44.8mins
90th = 27.8mins
Achievements/AwardsAchievements/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
Remaining ChallengesRemaining Challenges
Delayed Times in DD2B/DIDO
Outside Limited Resources
ED Physician Turnover
EMS FMC to PCI <90 minutes – Mission Lifeline Recommendation
Contact Info:Contact Info: