South Dakota State of the State - Tom Stys, MD - SD Chairwcm/@mwa/... · PCI hospitals now being...

Improving the System of Care for STEMI Patients

The State of the State in South Dakota

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The Ideal STEMI System of Care

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The Ideal EMS

In an ideal system:

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EMS/Hospital Equipment and Receiving Software

131 EMS agencies in the state are now LIVE with transmission of 12 lead ECGs via software or fax to their local hospitals.

46/50 hospitals have LIFENET software in place. The four remaining are utilizing electronic fax option (which is equally fast)

PCI hospitals now being offered $10,000 stipend to assist with interoperability of data collection with CATH-PCI. This eliminates close to 60 duplicate data points

Referring Hospitals have sent reports indicating additional equipment needed.

Additional funding will be available for referral hospitals and EMS agencies to improve infrastructure. The process and timeline details will be announced soon.

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Total transmissions for all accounts in the state of South Dakota for 2010, 2011 and 2012

source-Physio-Control, Inc.

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Year ECG Total Transmissions in SD

2010 1377

2011 1709

2012 2580


Hospital and EMS Education

Hospital education is approximately 80% complete for year two.

Distribution of 2,000 Learn Rapid STEMI ID keycard and educational books to EMS and hospital Emergency Departments. They were administered to every licensed EMT in the state. Based on course feedback, focused training is now being implemented.

Education has been made available to all of the 133 EMS agencies. Ongoing training opportunities continue to be offered on site and throughout the state.

An ongoing training plan for both hospitals and EMS agencies continues to be a priority.

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Referral Hospital Educational Sustainment


EMS Agency Response (83) on Resources to Sustain Training


The Reality of Today’s Patients

Not all STEMI patients call 9-1-1

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“Walk-in” patients hinder:

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Symptom Onset to First Medical Contact: All STEMI admissions who arrived via EMS AND have a reported date/time

of symptom onset before first medical contact, excluding transfers in.

12/3/2012 ©2010, American Heart Association 10

South Dakota2012

Nation2012

Median Time from

Symptom Onset to First

Medical Contact

minutes

45

minutes

52

Median Time from

Symptom Onset to Arrival

via POV

minutes

94

minutes

118

Symptom Onset to Medical ContactSymptom Onset to Arrival via POV: All STEMI admissions who arrived via POV AND have

a reported date/time of symptom onset before arrival, excluding transfers in.


Public Education

Six local EMS providers were featured on television commercials that have aired across the state promoting the critical message to not ignore heart attack symptoms and to dial 9-1-1 immediately.

South Dakota was featured in a web-based reality television show called “Code STEMI.”

We secured 15,003,408 total media impressions/placements, which was paid by the grant support

Tool kits will soon be available on the SD Mission: Lifeline website. Materials can be ordered free of charge.

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Tool Kits Now Available

Online Downloadable materials - www.heart.org/missionlifelinesd

Newsletter Sample Articles

Radio Interview – key point templates

Link M:L PSA/Commercials to Organizational Website (directions)

Facebook posts

Collateral Material Order Form

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The Ideal STEMI-Receiving Hospital

In an ideal system:

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South Dakota vs. The Nation – at a glance (Q1 2012)Measure State Data

Metric SD Score National Score5

Overall Mission Lifeline

96.6% 95.2%

Composite Score

Time to Primary 92.1% 94.1%

PCI <= 90 min

Mission: Lifeline

First Medical Contact to

58.3% 64.9%

Primary PCI <= 90 min

Reperfusion Therapy 93.3% 90.9%

Aspirin at Arrival 100.0% 99.0%

Aspirin at Discharge 100.0% 98.9%

Beta Blocker 98.3% 98.0%

at Discharge

Statin at Discharge 97.4% 99.2%

ACE-I or ARB for 100.0% 93.1%

LVSD at Discharge

Adult Smoking 100.0% 99%

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In-hospital Mortality

South Dakota2012

Nation2012

Unadjusted death

overall

5% 6%


In-hospital STEMI Mortality


The Ideal STEMI-Referral Hospital

In an ideal system:

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First Door (Referral Facility Arrival) to Balloon

SouthDakota2012

Nation2012

% within 90 minutes 4% 30%

Median time in minutes 160 minutes 107minutes

Arrived at referral facility

by EMS

154 minutes 109 minutes

Arrived at referral facility

by POV

167 minutes 107 minutes

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All STEMI admissions indicated for immediate primary PCI who were transferred in, had STEMI diagnosed on first ECG, and had a reported first device activation date/time AFTER arrival at the first facility, excluding patients administered thrombolytics prior to PCI, non-primary PCI, documented non-system reason for delay in PCI, and arrival at first facility to PCI time > 12 hours.

12/3/2012 ©2010, American Heart Association


• 27 surveys completed to date

• Increased awareness of cardiac response times

• Enhanced communication b/w pre-hospital providers

• Enhanced ability to transmit ECG to receiving facility

• Difficult for referral hospitals to afford equipment & training without funding

• Positive impact on community (better care of STEMI & NSTEMI patients)

• Field ECG Improved door to TNK times

• Updated STEMI education for RN’s & EMS & increased awareness of AHA’s Mission: Lifeline

• Additional equipment needs noted: defibrillators, portable compatible monitors, upgrades to include capnography, istat machines to run troponin levels when lab is not available.

• Some invoice & transmission questions. AHA working w/ vendors to resolve.

Referral Hospital Survey Results Summary:



Median length of stay at referral facility: All STEMI admissions who were transferred in and have a reported date/time of transfer from outside facility after arrival at outside facility, excluding patients with length of stay at outside facility >12 hours.

South Dakota2012

Nation2012

Median Length of Stay at Referral Facility

Minutes101.5

Minutes61

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STEMI Referral Facility/Non-PCI Hospital LOS (Door in Door Out)


Formal Evaluation of Mission: Lifeline SD through the Rupri Center

The Helmsley Charitable Trust has used The Rupri Center for evaluation of the Avera eCare

A formal evaluation is part of the South Dakota Mission: Lifeline approved budget.

The primary goal of the program evaluation is to identify a set of recommendations related to the sustainability and spread of the program. The primary question for The Helmsley Charitable Trust is how best to use their resources to improve healthcare in the upper Midwest.

Determining which features of the current Mission: Lifeline implementation approach are working well and which could be enhanced will help the AHA and The Trust develop plans for sustaining and spreading Mission: Lifeline in South Dakota and other states.

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Partners for Success in South Dakota-Do we have everyone at the table?

Patients and care givers

EMS providers

Physicians, nurses and other providers

STEM-referral (non-PCI) hospitals

STEMI-receiving (PCI-capable) hospitals

Health systems

Departments of health

EMS regulatory authority / office of EMS

Rural health associations

Quality improvement organizations

Third-party payers

State and local policymakers

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Hospital Comments…


“It has improved the abilities of our facility to be made aware of a potential AMI coming in, to call in the appropriate staff as we are a rural Critical Access Hospital and do not have physicians, lab and x-ray in house 24/7”.

St. Michael's Hospital Avera Tyndall, SD

“Created a new and useful communication tool for pre hospita services as well as improved communication with other facilities for the care of transfer patients ”.

Custer Regional Hospital, Custer, SD

“Given providers the opportunity to potentially tran sfer an acute MI patient to a tertiary hospital faster, by having the transport agency rea dy for lift off when the EKG is received in the ED ”.

Sanford Hospital Webster, Webster, SD

“Travis did an excellent job communicating to us the STEMI information ”.Avera Sacred Heart Hospital

Improving the System of Care for STEMI Patients 24

South Dakota State of the State - Tom Stys, MD - SD Chairwcm/@mwa/... · PCI hospitals now being...

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