PoCT Troponin Improving Patient Outcomes in Rural and Remote Settings
|
|
|
- Meryl James
- 8 years ago
- Views:
Transcription
1 PoCT Troponin Improving Patient Outcomes in Rural and Remote Settings Dr Philip Tideman FRACP Cardiologist and Clinical Director Integrated Cardiovascular Clinical Network Country Health South Australia Local Health Network IFCC POCT Satellite Meeting: PoCT Enabling Patient-Centred Care Istanbul 22 July 2014
2 AUSTRALIA South Australia Population: 1.5 million Capital: Adelaide 1.07 mill.
3 SA Country Health Local Health Network Acute Care 66 hospitals Total workforce 7,100 Nurses ~3,600 Salaried Drs - 46 GPs 424 GP registrars 41 Allied Health - 620
4 SA Country Health Services Population: 420,000 (28% of total) Very low population density Age profile: 14% > 65 years Catchment populations: ,000 per hospital On-site Laboratories (on-call only after-hours) - 10 Significant shortage of doctors and nurses in primary care and hospitals. Significant shortage of Medical Specialists only 3 resident Adult Consultant Physicians Tertiary/teaching hospitals highly centralised
5 Population Outcomes CHD Mortality Trends Australia D e a t h s p e r 1 0 0, 0 0 P o p Year What s the problem? Males Females Dietary changes Reduced intake of saturated fats Less smoking Better detection and treatment of hypertension Better treatments for heart problems
6 Geographic Variation in Coronary Heart Disease in Australia more deaths than expected from acute myocardial infarction resulted in mortality rates from CHD up to 30% higher in men and 21% higher in women living outside of capital city statistical divisions. The gap widened between 1986 and 1996 and is greater amoung younger age groups Sexton and Sexton, MJA 2000; 172: 370-4
7 Geographic Variation (SA) 250 Deaths per 100,000 pop Males Rural Females Rural Males City Female City Sexton and Sexton, MJA 2000
8 Evolution of the Network Early Research Troponin evaluation Short Stay Chest Pain Assessment Unit & Protocols at Flinders Medical Centre Concept development and initial consultation Pilot Phase. AHMAC grant Dec SA Generational Health Reform process begins Expansion to a Regional Network (icarnet) Expansion to operational statewide network State Govt funding for Integrated Cardiovascular Clinical Network SA (iccnet) Statewide Clinical Networks (Statewide Service Strategy ) under SA Health Care Plan 2010 iccnet integrated into CHSA.
9 Clinical Network Operations: Workforce Critical Components Rural generalist doctors and nurses Systems of Care Clinical Tools and Clinical Systems Education, Training and Skills Maintenance Access to Essential Equipment and ICT Services Research, Development and Evaluation
10 Clinical Tools & Systems Evidence Based Clinical Pathway for Chest Pain/ACS Presentations Incorporating STEMI Protocols Digital ECG Management Tenectaplase and other Critical Formulary Distribution and Stock Rotation systems Comprehensive POCT Pathology Integrated Consultant Cardiologist Backup and Support Comprehensive CV CME for all members of the team Robust Communication and Clinical Information Sharing Systems with inbuilt Redundancy Clinical Service Integration between all Service Providers Electronic Medical Records Cardiac Rehabilitation & Secondary prevention (CATCH)
11 Clinical Resources in All Rural Hospitals for ACS Management 1. Integrated, Evidencebased Clinical Pathways Immediate Steps Initial Diagnosis and Risk stratification Initial Treatment Further Diagnostic Testing and Risk Stratification Triage Chest pain / ACS SOB / CHF AF (in development)
12 Clinical Resources in Rural Hospitals for ACS Management 2. CHSA Digital ECG Management System Generation, distribution, reporting, storage, retrieval and analysis of ECGs in a digital format Assists: Recall of old ECGs Serial comparison of current ECGs Distribution of high quality ECGs to multiple providers Integration of ECG into EMR
13 An Example ECG FACSIMILE DIGITAL ECG into INBOX
14 Clinical Resources in Rural Hospitals for ACS Management 3. Universal Access to Single-Bolus, Fibrin Specific Thrombolytic Tenectaplase Tenectaplase (Metalyse) 24/7 availability in every hospital, RFDS Pt Augusta, other sites
15 Clinical Resources in Rural Hospitals for ACS Management Cobas Hemocue Epoc 4. Extended POCT Pathology Troponin T Pro BNP D-Dimer Hb, WCC Na, K Creatinine Glucose HbA1c Accu-chek Inform II istat Lactate ABG (po2, pco2, ph) LFT Lipids Coagulation - INR
16 Clinical Resources in Rural Hospitals for ACS Management Cardiology Consultant Advice 24/7 service aim <10 min response time single statewide telephone number Ph Or option #1 MedStar Ph 13STAR Built-in redundancy (up to five layers, 5 minute programmed escl cycle)
17 Clinical Resources in Rural Hospitals for ACS Management RFDS Base, Pt Augusta 6. Seamless Transfer to Tertiary Cardiac Care for High Risk Patients Common clinical pathways Shared formulary and medication protocols IV GTN IV Tirofiban Integrated care between: Rural hospitals Rural doctors, nurses, allied health Tertiary specialists and cardiology services Ambulance service Aeromedical Evacuation and Medical Retrieval services
18 Digital TeleHealth Network (DTN) Video-Conferencing Low risk (Troponin negative) chest pain assessment No doctor on-site ED resuscitation assistance Complex inpatients not for transfer (palliative care) Routine follow-up and urgent new consultations Remote support for GP based Exercise ECG testing Tele-auscultation POCT training, accreditation, technical support Continuing Medical Education
19 SA Rural Pathology Characteristics Most hospitals without on-site Laboratory s km distance to Lab Increased risk of pre-analytical errors Unacceptably long turn-around times Low throughput per site High specimen transport cost Current recommendation from American College Cardiology/American Heart Association Guidelines (Circulation 2000) is that cardiac marker results be available within 60 minutes and preferably within 30 minutes. Conclusion: Unable to risk stratify patients in rural centres presenting with chest pain/possible ACS without access to point-of-care pathology.
20 Rural Emergency POCT Troponin T NT-proBNP D-Dimer Hb, WCC with diff Na, K Creatinine Glucose HbA1c Lactate ABG (po2, pco2, ph) LFT Lipids Coagulation INR CRP Stroke panel Strep A BHCG Fibronectin
21 The Role of an Integrated Clinical Network in Provision of POCT Evaluation and choice of platform Provision and technical support of equipment Consumable supply (purchasing power) Staff education / training / accreditation Quality control and quality assurance Sharing of operational information between providers, eg. funding, practice organisation Networked results management (in process) Research clinical, population and health service outcomes
22 Elecsys vs Cobas h232 N=166 Cobas h232 = hs TropT
23 hs TropT vs cobas h paired results for 805 patients 107 numerical result did not agree (2.3%) involving 62 patients 9 patients (1%) different clinical picture 26 patients ng/l on cobas <14 on hstropt Reported to Roche as was an unusual finding only affecting 2 machines and one lot number swapped out and no further issue 27 patients with chronic release hs Troponin ( on cobas h232)
24 Troponin T Quality Program cobas h232 (Troponin T) Internal Quality Control Internal quality control should be tested a minimum of once (1) per month. Quality control results should be recorded on the quality control sheet provided by iccnet CHSA and faxed to the iccnet CHSA office on during the first week of each month. External Quality Control External quality controls for the year will be sent to each site in January/February along with a result reporting schedule. The sheet provided with external quality controls will show which sample should be run each month and the due date. If using NT-proBNP strips at your site, the same sample is tested for NT-proBNP after the Troponin test. External quality control samples should be run before the due date and results faxed to the iccnet CHSA office IQC Check The IQC should be performed a minimum of once (1) per day, alternating between the two (2) levels.
25 Internal Trop T Results CV % over 70 Instruments 19.5% 66% Sites Report CV <20% Number of Sites CV
26 EQA Troponin Report
27
28 Regional In-Hospital ACS Deaths % In -H o s p ita l A C S D e a th s /92 92/93 93/94 94/95 95/96 96/97 97/98 98/99 99/00 00/01 01/02 02/03 03/04 04/05 05/06 06/07 Financial Year icarnet Commenced April 2001 Regional network fully operational Southern Metro (Moving Average) South East (Actual) South East (Moving Average)
29
30
31 30-day Mortality Risk adjusted Odds-ratio for death at 30 days post MI for rural vs metro patients: 2001 : 1.69 (95% CI, ; P <0.001) 2010 : 0.92 (95% CI, ; P=0.44) Implementation of iccnet model of care in rural hospitals was associated with a 22% reduction in 30 day AMI mortality
32 PoCT Pathology: How to Use Clinical Integration The provision of POCT was essential but not sufficient alone for optimal outcomes in rural and remote settings POCT should be part of an integrated approach to clinical practice improvement initiatives.
33 Improving Access to Quality Care Time critical processes of care Geographic isolation Distance, low population density, climatic conditions, limited infrastructure Socio-economic disadvantage Developed countries Developing countries Other causes of isolation Very large populations with low density of appropriately trained and skilled clinicians
34
Samsung POINT OF CARE Systems - Cardiac/Acute Care Biomarkers LABGEO IB Clinical Chemistry Analytes LABGEO PT
Samsung POINT OF CARE Systems - Cardiac/Acute Care Biomarkers LABGEO IB Clinical Chemistry Analytes LABGEO PT Alexander Belenky, PhD Director -Product Development Samsung - Nexus-Dx Edward Brennan, PhD
Redefining the NSTEACS pathway in London
Redefining the NSTEACS pathway in London Sotiris Antoniou Consultant Pharmacist, Cardiovascular Medicine, Barts and The London NHS Trust and Project Lead, North East London Cardiovascular and Stroke Network
Coronary Artery Disease leading cause of morbidity & mortality in industrialised nations.
INTRODUCTION Coronary Artery Disease leading cause of morbidity & mortality in industrialised nations. Although decrease in cardiovascular mortality still major cause of morbidity & burden of disease.
REFERRAL HOSPITAL. The Importance of Door In Door Out Time DIDO
REFERRAL HOSPITAL The Importance of Door In Door Out Time DIDO Time to Treatment is critical for STEMI patients For patients with ST-segment elevation myocardial infarction (STEMI), percutaneous coronary
cobas h 232 POC system On-the-spot care & share
cobas h 232 POC system On-the-spot care & share Confident on-the-spot diagnosis of patients presenting with life-threatening chest pain or dyspnea. Plus wireless connectivity for immediate, streamlined
Regional Cardiac Rehabilitation for Northwestern Ontario
Regional Cardiac Rehabilitation for Northwestern Ontario Lori Marshall RPh, BScPhm, MHA,CHE Vice President Thunder Bay Regional Health Sciences Centre marshall@tbh.net TBRHSC Cardiac Rehab History TBRHSC
Stent for Life Initiative How can we improve system delay and patients delay in STEMI
Stent for Life Initiative How can we improve system delay and patients delay in STEMI Z. Kaifoszova SFL Initiative Europe 2011 Stent for Life Initiative 10 countries participate in the program Declaration
4/24/2015. Urgent, STAT, Super STAT, ASAP! Achieving timely lab testing for the Emergency Department. Learning Objectives.
Urgent, STAT, Super STAT, ASAP! Achieving timely lab testing for the Emergency Department Nichole Korpi-Steiner, PhD, DABCC, FACB University of North Carolina Chapel Hill, NC Learning Objectives Describe
Cardiac Rehab and Success
One Health System, Better Outcomes Department of Health and Human Services, GPO Box 125, Hobart, TAS, 7001 RE: THO North Cardiac Health and Rehabilitation Submission on the Green Paper The Cardiac Health
Cardiac Clinical Advisory Group Cardiology Services
Cardiac Clinical Advisory Group Response to Green Paper The Cardiac Clinical Advisory Group (CAG) is pleased to have this opportunity to provide this response to the Government s Green Paper for. There
Telemedicine Bringing specialist care to remote areas
Telemedicine Bringing specialist care to remote areas Dr Graeme Maw Staff Specialist in Emergency Medicine Director Axonal Abstract In 2006 Queensland Health trialed telemedicine (the remote delivery of
Management of Acute Coronary Syndrome / NSTEMI
CLINICAL GUIDELINE Management of Acute Coronary Syndrome / NSTEMI For use in (clinical areas): For use by (staff groups): For use for (patients): Document owner: Status: All clinical areas Medical and
Making Telehealth Sustainable in South Australia Dr Victoria Wade
Making Telehealth Sustainable in South Australia Dr Victoria Wade Clinical Director, Adelaide Unicare e-health and Telehealth Unit Research Fellow, Discipline of General Practice The University of Adelaide
URN: Family name: Given name(s): Address:
State of Queensland (Queensland Health) 2015 Licensed under: http://creativecommons.org/licenses/by-nc-nd/3.0/au/deed.en Contact: Clinical_Pathways_Program@health.qld.gov.au Facility:... Clinical pathways
How to Maximize Your Lab s Value to Cardiac Care Sammie Sue Hendrix Laboratory Director Citizens Medical Center, Victoria Texas
How to Maximize Your Lab s Value to Cardiac Care Laboratory Director Citizens Medical Center, Victoria Texas All rights reserved. Today s Presentation This presentation is sponsored by Siemens Healthcare
RISK STRATIFICATION for Acute Coronary Syndrome in the Emergency Department
RISK STRATIFICATION for Acute Coronary Syndrome in the Emergency Department Sohil Pothiawala FAMS (EM), MRCSEd (A&E), M.Med (EM), MBBS Consultant Dept. of Emergency Medicine Singapore General Hospital
Osama Jarkas. in Chest Pain Patients. STUDENT NAME: Osama Jarkas DATE: August 10 th, 2015
STUDENT NAME: Osama Jarkas DATE: August 10 th, 2015 PROJECT TITLE: Analysis of ECG Exercise Stress Testing and Framingham Risk Score in Chest Pain Patients PRIMARY SUPERVISOR NAME: Dr. Edward Tan DEPARTMENT:
What is a Heart Attack? 1,2,3
S What is a Heart Attack? 1,2,3 Heart attacks, otherwise known as myocardial infarctions, are caused when the blood supply to a section of the heart is suddenly disrupted. Without the oxygen supplied by
RE: Australian Safety and Quality Goals for Health Care: Consultation paper
10 February 2012 Mr Bill Lawrence AM Acting CEO Australian Commission on Safety and Quality in Health Care GPO Box 5480 Sydney NSW 2001 Email: goals@safetyandquality.gov.au Dear Mr Lawrence RE: Australian
Module overview Please note: This module must be read in conjunction with the Fundamentals of the Framework (including glossary and acronym list).
Cardiac services CSCF v3.2 Module overview Please note: This module must be read in conjunction with the Fundamentals of the Framework (including glossary and acronym list). Cardiac services are a specialised
Measures for the Australian health system. Belinda Emms Health Care Safety and Quality Unit Australian Institute of Health and Welfare
Measures for the Australian health system Belinda Emms Health Care Safety and Quality Unit Australian Institute of Health and Welfare Two sets of indicators The National Safety and Quality Indicators Performance
Telemedicine in the Prevention and Monitoring of Heart Disease
Telemedicine in the Prevention and Monitoring of Heart Disease Prof. Dr. med. Friedrich Köhler 26. April 2012 Charité-Universitätsmedizin Berlin Facts Founded in 1710 11 Nobel laureates 12.922 employees
Townsville NBN diabetes in-home monitoring trial Dr Karen Carlisle Townsville-Mackay Medicare Local
Townsville NBN diabetes in-home monitoring trial Dr Karen Carlisle Townsville-Mackay Medicare Local The Trial is supported by funding from the Australian Government under the Digital Regions Initiative
Health Policy, Administration and Expenditure
Submission to the Parliament of Australia Senate Community Affairs Committee Enquiry into Health Policy, Administration and Expenditure September 2014 Introduction The Australian Women s Health Network
STEMI Systems of Care
STEMI Systems of Care Rich Lundy, MBA, RRT, FACCA Vice President Heart and Vascular Services, Imaging Services Cone Health May 2013 STEMI Systems of Care Objectives Demonstrate the clinical and operational
OVERVIEW OF PALLIATIVE CARE SERVICES IN NEW SOUTH WALES 2006
OVERVIEW OF PALLIATIVE CARE SERVICES IN NEW SOUTH WALES 2006 September 2009 Jill Hardwick A report commissioned by the Cancer Institute NSW Cancer Institute NSW Australian Technology Park Biomedical Building
STATEMENT ON THE DELINEATION OF EMERGENCY DEPARTMENTS
STATEMENT Document No: S12 Approved: Jul-97 Last Revised: Nov-12 Version No: 05 STATEMENT ON THE DELINEATION OF EMERGENCY DEPARTMENTS 1. PURPOSE This document defines the minimum requirement for a health
ADMINISTRATIVE MANUAL Policy and Procedure
ADMINISTRATIVE MANUAL Policy and Procedure TITLE: Point of Care Testing NUMBER: CH 30-111 (Laboratory Diagnostic Bedside Testing) Effective Date: January 2014 Page 1 of 6 Applies To: Holders of Administrative
The new Heart Failure pathway
The new Heart Failure pathway An integrated and seamless Strategy Dr Sunil Balani Definition of Heart Failure The inability of the heart to pump blood at a rate commensurate with the requirements of metabolising
What are the PH interventions the NHS should adopt?
What are the PH interventions the NHS should adopt? South West Clinical Senate 15 th January, 2015 Debbie Stark, PHE Healthcare Public Health Consultant Kevin Elliston: PHE Consultant in Health Improvement
Community health care services Alternatives to acute admission & Facilitated discharge options. Directory
Community health care services Alternatives to acute admission & Facilitated discharge options Directory Introduction The purpose of this directory is to provide primary and secondary health and social
The Role of Insurance in Providing Access to Cardiac Care in Maryland. Samuel L. Brown, Ph.D. University of Baltimore College of Public Affairs
The Role of Insurance in Providing Access to Cardiac Care in Maryland Samuel L. Brown, Ph.D. University of Baltimore College of Public Affairs Heart Disease Heart Disease is the leading cause of death
Requirements for Provision of Outreach Paediatric Cardiology Service
Requirements for Provision of Outreach Paediatric Cardiology Service Dr Shakeel A Qureshi, Consultant Paediatric Cardiologist, Evelina Children s Hospital, London, UK On behalf of British Congenital Cardiac
HealthCare Partners of Nevada. Heart Failure
HealthCare Partners of Nevada Heart Failure Disease Management Program 2010 HF DISEASE MANAGEMENT PROGRAM The HealthCare Partners of Nevada (HCPNV) offers a Disease Management program for members with
Improving Health Outcomes and Reducing Costs with Video Conferencing Technology
Case Study Intel Intel Health & Life Sciences Improving Health Outcomes and Reducing Costs with Video Conferencing Technology The fundamental concept is to provide the patient with care where they are
Is it really so? : Varying Presentations for ACS among Elderly, Women and Diabetics. Yen Tibayan, M.D. Division of Cardiovascular Medicine
Is it really so? : Varying Presentations for ACS among Elderly, Women and Diabetics Yen Tibayan, M.D. Division of Cardiovascular Medicine Case Presentation 69 y.o. woman calls 911 with the complaint of
National Assembly for Wales: Health and Social Care Committee
2 Ashtree Court, Woodsy Close Cardiff Gate Business Park Cardiff CF23 8RW Tel: 029 2073 0310 wales@rpharms.com www.rpharms.com 18 th October 2011 Submission to: Call for Evidence: Response from: National
DISCLOSURES RISK ASSESSMENT. Stroke and Heart Disease -Is there a Link Beyond Risk Factors? Daniel Lackland, MD
STROKE AND HEART DISEASE IS THERE A LINK BEYOND RISK FACTORS? D AN IE L T. L AC K L AN D DISCLOSURES Member of NHLBI Risk Assessment Workgroup RISK ASSESSMENT Count major risk factors For patients with
Cardiac Rehab and Primary Care: Avoiding Losses in Care Transitions. Neville Suskin Heart & Stroke Clinical Update 2012
Cardiac Rehab and Primary Care: Avoiding Losses in Care Transitions Neville Suskin Heart & Stroke Clinical Update 2012 1 Disclosure Med. Director SJHC CR Co-principal of Lawson e-cr application LCVIS SJHC
How can registries contribute to guidelines? Nicolas DANCHIN, HEGP, Paris
How can registries contribute to guidelines? Nicolas DANCHIN, HEGP, Paris Pros and cons of registers Prospective randomised trials constitute the cornerstone of "evidence-based" medicine, and they therefore
All patients presenting to the Emergency Department with symptoms suggestive of
APPENDIX: Online Data Supplements Clinical Trial Inclusion and Exclusion Criteria All patients presenting to the Emergency Department with symptoms suggestive of acute coronary syndrome (ACS) were screened
Journal Club: Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy by the AIM-HIGH Investigators
Journal Club: Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy by the AIM-HIGH Investigators Shaikha Al Naimi Doctor of Pharmacy Student College of Pharmacy Qatar University
3/2/2010 Post CABG R h e bili a i tat on Ahmed Elkerdany Professor o f oof C ardiac Cardiac Surgery Ain Shams University 1
Post CABG Rehabilitation i Ahmed Elkerdany Professor of Cardiac Surgery Ain Shams University 1 Definition Cardiac rehabilitation services are comprehensive, long-term programs involving : medical evaluation.
Managing POCT: Trying to Control Testing in an Out-of-Control Environment. William Clarke, PhD, MBA, DABCC Johns Hopkins School of Medicine 3/24/11
Managing POCT: Trying to Control Testing in an Out-of-Control Environment William Clarke, PhD, MBA, DABCC Johns Hopkins School of Medicine 3/24/11 Learning Objectives Participants should be able to: Discuss
Physician and other health professional services
O n l i n e A p p e n d i x e s 4 Physician and other health professional services 4-A O n l i n e A p p e n d i x Access to physician and other health professional services 4 a1 Access to physician care
National Clinical Programmes
National Clinical Programmes Section 3 Background information on the National Clinical Programmes Mission, Vision and Objectives July 2011 V0. 6_ 4 th July, 2011 1 National Clinical Programmes: Mission
Inquiry into palliative care services and home and community care services in Queensland. Submission to the Health and Community Services Committee
Inquiry into palliative care services and home and community care services in Queensland Submission to the Health and Community Services Committee August, 2012 1 Introduction The Queensland Nurses Union
Overview Of Cardiac Rehabilitation Programs In Malaysia Updates & Innovations
Overview Of Cardiac Rehabilitation Programs In Malaysia Updates & Innovations Aizai Azan Rahim Cardiology Department National Heart Institute Topics Historical Perspective Of Cardiac Rehabilitation CPG
POSITION DESCRIPTION. CLOSING DATE FOR APPLICANTS: 2 nd January 2015. Salary Range $95,000 - $105,000 including Super and Salary Packaging benefits
POSITION DESCRIPTION CLOSING DATE FOR APPLICANTS: 2 nd January 2015 Salary Range $95,000 - $105,000 including Super and Salary Packaging benefits GPcare Practice Manager: 0.8 1.0FTE (negotiable), 2 year
HAMAD MEDICAL CORPORATION. Family Medicine (FM) Consultant Posts in Emergency Medicine. Job Description/Person Specifications.
HAMAD MEDICAL CORPORATION Family Medicine (FM) Consultant Posts in Emergency Medicine Job Description/Person Specifications September 2014 Page 1 of 10 CONTENTS Table of Contents 1. Hamad Medical Corporation
Measuring quality along care pathways
Measuring quality along care pathways Sarah Jonas, Clinical Fellow, The King s Fund Veena Raleigh, Senior Fellow, The King s Fund Catherine Foot, Senior Fellow, The King s Fund James Mountford, Director
Job Description. Nurse Consultant Cardiac Rhythm Management. Lead Nurse, Division of Cardiothoracic Services. Job purpose
Job Description Position: Accountable To: Responsible To: Hours of Duty: Location: Nurse Consultant Cardiac Rhythm Management Director of Nursing Lead Nurse, Division of Cardiothoracic Services 37 ½ hours
THE SPECIALIST CARDIOLOGY WORKFORCE IN AUSTRALIA
Australian Medical Workforce Advisory Committee THE SPECIALIST CARDIOLOGY WORKFORCE IN AUSTRALIA SUPPLY AND REQUIREMENTS 1998-2009 AMWAC Report 1999.5 August 1999 i Australian Medical Workforce Advisory
KEEPING ABREAST OF FUTURE NEED:
KEEPING ABREAST OF FUTURE NEED: A REPORT INTO THE GROWING DEMAND FOR BREAST CARE NURSES australian healthcare & hospitals association FOREWORD The demand for breast cancer nursing care in Australia is
CARDIAC REHABILITATION
Paul Peacock Cardiac Rehabilitation Nurse Friday, 4 August 2006 1 The rehab Team Chris Murphy Kate O Reilly Paul Peacock Increased to 2 FTEs March 06 Wellington & Kapiti Coast MDT involvement Friday, 4
Submission to the Standing Committee on Finance and Economic Affairs - 2015 Pre-Budget Consultations -
Submission to the Standing Committee on Finance and Economic Affairs - 2015 Pre-Budget Consultations - Presented by: James Swan, MD, F.R.C.P.(C) F.A.C.C. President Ontario Association of Cardiologists
Stroke: Major Public Health Burden. Stroke: Major Public Health Burden. Stroke: Major Public Health Burden 5/21/2012
Faculty Prevention Sharon Ewer, RN, BSN, CNRN Stroke Program Coordinator Baptist Health Montgomery, Alabama Satellite Conference and Live Webcast Monday, May 21, 2012 2:00 4:00 p.m. Central Time Produced
ALBERTA PROVINCIAL STROKE STRATEGY (APSS)
ALBERTA PROVINCIAL STROKE STRATEGY (APSS) Stroke Systems of Care Key Components APSS Pillar Recommendations March 28, 2007 1 The following is a summary of the key components and APSS Pillar recommendations
S Hutton, A Inglis, C McKiernan, S Hearns, P Campbell, M Lindsay
Emergency Medical Retrieval Service (EMRS) www.emrs.scot.nhs.uk Standard Operating Procedure Public Distribution Title Acute Coronary Syndrome Version 4 Related Documents Author Alan Exton Reviewer S Hutton,
The National Service Framework for Cardiac Disease: Strategic Aims and Implementation A Cardiac Work Programme for Wales
The National Service Framework for Disease: Strategic Aims and A Work Programme for Wales Disease Strategic Framework 2008-11 1 CONTENTS Page 1. Introduction 3 2. Part 1 Strategic Aims 3 3. Part 2 Standard
Managing Patients with Multiple Chronic Conditions
Best Practices Managing Patients with Multiple Chronic Conditions Advocate Medical Group Case Study Organization Profile Advocate Medical Group is part of Advocate Health Care, a large, integrated, not-for-profit
Māori Pathways to and Through Health Care for STEMIs in New Zealand. Summer Studentship Research by Ellie Tuzzolino- Smith
Māori Pathways to and Through Health Care for STEMIs in New Zealand Summer Studentship Research by Ellie Tuzzolino- Smith Terminology & Current Practice STEMI: S-T elevation Myocardial Infarction. Determined
Approved: Acute Stroke Ready Hospital Advanced Certification Program
Approved: Acute Stroke Ready Hospital Advanced Certification Program The Joint Commission recently developed a new Disease- Specific Care Advanced Certification program for Acute Stroke Ready Hospitals
SOUTH EAST WALES CARDIAC NETWORK INTEGRATED CARE PATHWAY CARDIAC REHABILITATION MAY 2005
Name Address SOUTH EAST WALES CARDIAC NETWORK INTEGRATED CARE PATHWAY CARDIAC REHABILITATION MAY 2005 Ms / Miss / Mr / Mrs Addressograph Known as Telephone Number of Birth Hospital No. NHS No. Cardiac
Telehealth in the Home: Palliative Care, Aged Care and Clinical Rehabilitation in SA
Telehealth in the Home: Palliative Care, Aged Care and Clinical Rehabilitation in SA Funded by the Australian Government under the National Broadband Network (NBN) Enabled Telehealth Pilots Program Project
An important first step in identifying those at risk for Cardiovascular disease The Accutrend Plus system: from the makers of the ACCU-CHEK and
An important first step in identifying those at risk for Cardiovascular disease The Accutrend Plus system: from the makers of the ACCU-CHEK and CoaguChek systems Cardiovascular disease: the #1 killer in
Main Effect of Screening for Coronary Artery Disease Using CT
Main Effect of Screening for Coronary Artery Disease Using CT Angiography on Mortality and Cardiac Events in High risk Patients with Diabetes: The FACTOR-64 Randomized Clinical Trial Joseph B. Muhlestein,
Evaluation of First-Draw Whole Blood, Point-of-Care Cardiac Markers in the Context of the Universal Definition of Myocardial Infarction
Evaluation of First-Draw Whole Blood, Point-of-Care Cardiac Markers in the Context of the Universal Definition of Myocardial Infarction A Comparison of a Multimarker Panel to Troponin Alone and to Testing
Building and supporting a diabetes education workforce
Building and supporting a diabetes education workforce J Giles 1, K Visentin 1, P Phillips 2 1 Diabetes Outreach, The Queen Elizabeth Hospital and SA Department of Health, 2 Endocrine and Diabetes, The
BG MEDICINE. Corporate Presentation February 2013
BG MEDICINE Corporate Presentation February 2013 CONFIDENTIAL Oct 9, 2007 Forward-Looking Statements This presentation contains forward-looking statements regarding future events or the future financial
Marilyn Borkgren-Okonek, APN, CCNS, RN, MS Suburban Lung Associates, S.C. Elk Grove Village, IL
Marilyn Borkgren-Okonek, APN, CCNS, RN, MS Suburban Lung Associates, S.C. Elk Grove Village, IL www.goldcopd.com GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE GLOBAL STRATEGY FOR DIAGNOSIS, MANAGEMENT
Surprisingly Australia is a civilized and developed country! We have universal health care (more or less)!
Surprisingly Australia is a civilized and developed country! We have universal health care (more or less)! s About 21 million people live in a country of 7,692,024 square kilometers So we seem to have
Victorian Nurse Practitioner Project Phase 4, Round 4.11 - Chronic Disease Management
Victorian Nurse Practitioner Project Phase 4, Round 4.11 - Chronic Disease Management Eastern Health Multiple Sclerosis Nurse Practitioner Service Model April 2014 Prepared by Jodi Haartsen and Deanna
Improving PCI Benchmark times in a Non-PCI World
Improving PCI Benchmark times in a Non-PCI World May 2011 St David s Georgetown Hospital, Georgetown Texas Margaret Connors BSN, RN, CEN Kirk Sinclair BSN, RN, CEN National Processes/ Mission LifeLine
Secondary prevention of cardiovascular disease. A call to action to improve the health of Australians
Secondary prevention of cardiovascular disease A call to action to improve the health of Australians Secondary prevention of cardiovascular disease: Nine key action areas Secondary prevention of cardiovascular
Educational Goals & Objectives
Educational Goals & Objectives The Cardiology rotation will provide the resident with an understanding of cardiovascular physiology and its broad systemic manifestations. The resident will have the opportunity
Strategic Plan for Nurse Practitioners in the Northern Territory
Strategic Plan for Nurse Practitioners in the Northern Territory 2014-2016 www.nt.gov.au/health PAGE 1 NT Department of Health Office of the Chief Nursing and Midwifery Officer NT Department of Health
Cardiovascular Endpoints
The Malmö Diet and Cancer Study Department of Clinical Sciences Malmö University Hospital Lund University The Malmö Diet and Cancer Study CV-cohort Cardiovascular Endpoints End of follow-up: 31 Dec * Report:
Risk Factors of chronic complex co-morbidities. Aldo Pietro Maggioni, MD ANMCO Research Center Firenze, Italy
Risk Factors of chronic complex co-morbidities Aldo Pietro Maggioni, MD ANMCO Research Center Firenze, Italy Statement 1 In real world practice (and in clinical trials), complex co-morbidities are the
Outpatient/Ambulatory Rehab. Dedicated Trans-disciplinary Team (defined within Annotated References)
CARDIAC The delivery of Cardiac Rehab is unlike most other rehab populations. The vast majority of patients receive their rehab in outpatient or community settings and only a small subset requires an inpatient
CARDIAC REHABILITATION Winnipeg Region Annual Report 2013-14
CARDIAC REHABILITATION Winnipeg Region Annual Report 2013-14 PROGRAM OVERVIEW The Cardiac Rehabilitation Program (CRP) operates out of two medical fitness facilities in Winnipeg, the Reh- Fit Centre and
Evolution of the nurse practitioner role at a rural health service
Evolution of the nurse practitioner role at a rural health service Wendy James, Mandy Morcom Rural Northwest Health, VIC It has been well portrayed that despite rural and remote Australia making up over
The Cardiac Society of Australia and New Zealand
The Cardiac Society of Australia and New Zealand Guidelines on Support Facilities for Coronary Angiography and Percutaneous Coronary Intervention (PCI) including Guidelines on the Performance of Procedures
Chest Pain Center Accreditation
Chest Pain Center Accreditation Laboratory s Role Amy Cotner, RN Region Business Manager Critical Care Cardiac Copyright 2009 Siemens Medical Solutions USA, Inc. All rights reserved. Objectives: Understand
Better Outcomes for People Living with Chronic and Complex Health Conditions through Primary Health Care
Submission: Primary Health Care Advisory Group Discussion Paper (August 2015) Better Outcomes for People Living with Chronic and Complex Health Conditions through Primary Health Care August 2015 Contact
Cardiovascular Endpoints
The Malmö Diet and Cancer Study Department of Clinical Sciences Skåne University Hospital, Malmö Lund University The Malmö Diet and Cancer Study CV-cohort Cardiovascular Endpoints End of follow-up: 30
Barwon Medicare Local Annual Plan 2014-2015
Barwon Medicare Local Annual Plan 2014-2015 Strategic Directions All Barwon Medicare Local activities are underpinned by our organisational vision of well connected health systems in our community. Barwon
Louisiana Report 2013
Louisiana Report 2013 Prepared by Louisiana State University s Public Policy Research Lab For the Department of Health and Hospitals State of Louisiana December 2015 Introduction The Behavioral Risk Factor
Improving General Practice a call to action Evidence pack. NHS England Analytical Service August 2013/14
1 Improving General Practice a call to action Evidence pack NHS England Analytical Service August 2013/14 Introduction to this pack This evidence pack has been produced to support the call to action to
EMR Tutorial Acute Coronary Syndrome
EMR Tutorial Acute Coronary Syndrome How to find the Acute Coronary Syndrome AAA Home Page 1 of 26 Master Tool Bar Icon When the Template button is clicked you will be presented with the preference list.
Key Priority Area 1: Key Direction for Change
Key Priority Areas Key Priority Area 1: Improving access and reducing inequity Key Direction for Change Primary health care is delivered through an integrated service system which provides more uniform
Service Specification Template Department of Health, updated June 2015
Service Specification Template Department of Health, updated June 2015 Service Specification No. : 2 Service: Commissioner Lead: Provider Lead: Period: Anti-coagulation monitoring Date of Review: 31 st
Policy Paper: Accessible allied health primary care services for all Australians
Policy Paper: Accessible allied health primary care services for all Australians March 2013 Contents Contents... 2 AHPA s call to action... 3 Position Statement... 4 Background... 6 Healthier Australians
Coronary Heart Disease (CHD) Brief
Coronary Heart Disease (CHD) Brief What is Coronary Heart Disease? Coronary Heart Disease (CHD), also called coronary artery disease 1, is the most common heart condition in the United States. It occurs
Nurse Practitioner Role Primary Health Care In General Practice Setting.
Nurse Practitioner Role Primary Health Care In General Practice Setting. The role of a nurse practitioner is to provide autonomous patient consultations. It also involves working in collaboration with
Listen to your heart: Good Cardiovascular Health for Life
Listen to your heart: Good Cardiovascular Health for Life Luis R. Castellanos MD, MPH Assistant Clinical Professor of Medicine University of California San Diego School of Medicine Sulpizio Family Cardiovascular
CLINICAL GUIDELINE FOR THE MANAGEMENT OF HYPERGLYCAEMIA IN ADULTS WITH ACUTE CORONARY SYNDROME
CLINICAL GUIDELINE FOR THE MANAGEMENT OF HYPERGLYCAEMIA IN ADULTS WITH ACUTE CORONARY SYNDROME 1. Aim/Purpose of this Guideline This guideline is for the management of Adult patients with Diabetes Mellitus
Appendix L: HQO Year 1 Implementation Priorities
Appendix L: HQO Year 1 Implementation Priorities Chronic Obstructive Pulmonary Disease (Source: COPD Chairs) Non-Invasive Positive Pressure Ventilation Early Ambulation If possible, seek patient preferences
Yorkshire Ambulance Service NHS Trust. Performance and Quality Update September 2015
Yorkshire Ambulance Service NHS Trust Performance and Quality Update September 2015 Our Communities YAS is the only NHS provider serving the whole Yorkshire region Provides: A&E ambulance service; non-emergency
Progress on the System Sustainability Programme. Submitted to: NHS West Norfolk CCG Governing Body, 31 July 2014
Agenda Item: 9.1 Subject: Presented by: Progress on the System Sustainability Programme Dr Sue Crossman, Chief Officer Submitted to: NHS West Norfolk CCG Governing Body, 31 July 2014 Purpose of Paper: