NEBRASKA STEMI CONFERENCE 2015 Welcome 2013, American Heart Association 1
What is Mission: Lifeline? Mission: Lifeline is the American Heart Association s national initiative to advance the systems of care for patients with ST-segment elevation myocardial infarction (STEMI) and Out of Hospital Cardiac Arrest. The overarching goal of the initiative is to reduce mortality and morbidity for STEMI and OOHCA patients to and improve their overall quality of care 5/3/2015 2013, American Heart Association 2
AHA STAFF Michelle Scharnott Vice President, Quality & Systems Improvement American Heart Association, Midwest Affiliate Michelle.Scharnott@heart.org Gary W. Myers Director Mission: Lifeline South Dakota EMS Consultant for Midwest Affiliate American Heart Association, Midwest Affiliate Gary.Myers@heart.org Julie Smith Lifeline Nebraska American Heart Association, Midwest Affiliate Julie.Smith@heart.org Director Mission: 5/3/2015 2013, American Heart Association 3
AHA STAFF Beth Malina Director of Quality and System Improvement Kansas & Nebraska American Heart Association, Midwest Affiliate Beth Malina @heart.org Ngia Mua Administrative Associate Mission: Lifeline American Heart Association, Midwest Affiliate Ngia.Mua@heart.org Kathy Hill Grants Administrator American Heart Association, Midwest Affiliate Kahty.Hill@heart.org Mindy Cook, RN BSN Sr. Director Quality and System Improvement and Director Lifeline North Dakota, Minnesota American Heart Association, Midwest Affiliate Mindy.Cook@heart.org 5/3/2015 2013, American Heart Association 4
AHA STAFF Kevin Sypal Regional Vice President American Heart Association, Midwest Affiliate Kevin.Sypal@heart.org Lisa McClung Corporate Events Director American Heart Association, Midwest Affiliate Lisa.McClung@heart.org 5/3/2015 2013, American Heart Association 5
Leadership and Committee Participation NE M:L Taskforce: Statewide représentation Executive Leadership Committee: 3 participants : Dr. Matt Johnson Bryan Health Lincoln Dr. Doug Kosmicki CHI St. Francis Grand Island Dr. David Cornutt Regional West Medical Center - Scottsbluff Interventional Cardiology Steering Committee Dr. Steve Martin Hospital Advisory Committee: Dr. Ed Mlinek Bryan Health Lincoln EMS Advisory Committee: Dr. Don Rice Dr. Jim Smith Dr. John Bonta EMS Group STEMI Conference Planning Committee: Planned - Quality Committee: 5/3/2015 2013, American Heart Association 6
Nebraska Mission: Lifeline STEMI Program Support and System development Taskforce engagement and committee structure development EMS Equipment Allocation and placement PCI Capable Hospital receiving system placement and ACTION registry participation Annual Educational opportunities in Webinar and In-Person events with free continuing education credits offered Statewide STEMI public awareness Campaign Statewide EMS and Inter-hospital Facility Transport Guidelines Improving the System of Care for STEMI Patients 7
Mission: Lifeline Nebraska - Timeline MAY 2014 JULY 2014 AUG 2014 DEC 2014 JAN 2015 - MAY 2015 2015 AND BEYOND Mission: Lifeline Director Hired JULIE SMITH Contact with all PCI capable facilities - COMPLETED Met with DHHS / EMS Program director and specialists - COMPLETED Task Force Group CREATED Task Force leadership selected - COMPLETED Kick Off Task Force Meeting HELD 7.9.2014 Applications for EMS Services to be finalized and sent to services - COMPLETED EMS Advisory Committee Meeting and will review and determine eligibility IN PROGRESS Award of first round funding for equipment MOU and contract work for PCI capable hospitals begins. Funding to start fall of 2014 Advisory Committees will begin meeting.- IN PROGRESS Development of Guidelines NE approved System of Care Education - Statewide STEMI Guidelines Reporting 1 st quarter data for Action Registry participating hospitals. Second round funding for EMS equipment will begin Education through DHHS Advisory Committees will continue to meet as needed to review data Mission: Lifeline Statewide Conference Data collection continues Continued EMS equipment funding Hospital and EMS recognition Quality Improvement efforts statewide based on registry data Regional Education Conferences Annual Mission: Lifeline Statewide Conference Interventional Cardiology Steering Committee IN PROGRESS I 5/3/2015 2013, American Heart Association 8
Mission: Lifeline will: Promote ideal STEMI systems of care Help STEMI patients get the life-saving care they need in time Bring together healthcare resources into an efficient, synergistic system Improve overall quality of care The initiative is unique in that it: Addresses the continuum of care for STEMI patients Preserves a role for the local STEMI-referral hospital Understands the issues specific to rural communities Promotes different solutions/protocols for rural vs. urban/suburban areas Recognizes there is no one-size-fits-all solution Knows the issues of implementing national recommendations on a community level 9 Improving the System of Care for STEMI Patients
5/3/2015 2013, American Heart Association 10
Rural NE M:L Grant 5.3 Million Grant 2014 2017 The Leona M. and Harry B. Helmsley Charitable Trust - $4.1 million gift Peter Kiewit Foundation, The Fund for Omaha through the Omaha Community Foundation Valmont Foundation, Peed Foundation, Mid-Nebraska Community Foundation, Aaron and Rachel Wagner, COPIC Medical Foundation, Hamilton Community Foundation, Suzanne and Walter Scott Foundation, Ron and Carol Cope Charitable Fund, Dillon Foundation, Pinnacle Bank-Madison Branch, William and Ruth Scott Foundation, Allan Lozier Family Foundation, American National Bank, Midwest Affiliate of the American Heart Association, and an anonymous supporter. Improving the System of Care for STEMI Patients 11
Rural NE PCI Capable Hospitals PCI 24/7 1. Faith Regional Health Services Norfolk 2. Saint Francis Medical Center - Grand Island 3. Good Samaritan Hospital Kearney 4. Kearney Regional Medical Center Kearney 5. Great Plains Regional Medical Center North Platte 6. Rapid City Medical Center Rapid City SD. PCI Non 24/7 1. Mary Lanning Healthcare Hastings (Not 24/7 at this time) 2. Fremont Area Medical Center Fremont Not 24-7 2. Regional West Medical Center - Scottsbluff - Diagnostic ONLY 5/3/2015 2013, American Heart Association 12
Nebraska PCI Hospitals Where are the cath labs? Scottsbl uffdiagn ostic only N P Kearn ey G I Norfol k Fremon t Not 24/7 Lincoln Omah a Hastin gs- Not yet 24/7 5/3/2015 2013, American Heart Association 13
Opportunities for Improvement Are patients not aware of S&S and calling 911, thus causing a delay in treatment/out of hospital death prior to treatment? This supports the need for enhanced public awareness/education. Access to care? Do we currently have systems in place in which patients are not able to get to the appropriate facility in a timely fashion, thus supporting the need to improve systems of care so that patients are transported to a facility with a plan in place to treat based on guidelines. 5/3/2015 14
PCI Referring Hospitals o 65 Rural NE Referring Hospitals 12 L transmission or recognition equipment funding available starting in January of 2014 Referring Hospital Education has began Spring of 2014 5/3/2015 15
DIDO Goal 45 minutes or less! Observed in-hospital mortality was significantly higher among patients with DIDO times >30 minutes than among those with DIDO times <30 minutes
Scope of Project: Year 2 Taskforce Meeting Annual NE STEMI Conference Local, Regional, and State STEMI system of care development, optimizing the destination plans and protocols and feedback recommendation development. Referring Hospital Education Curriculum Development and Delivery Learn Rapid STEMI ID and STEMI Provider Manual Distribution Public Awareness Campaign Assessment, Development, and Delivery 17 Improving the System of Care for STEMI Patients
Scope of Project: Year 3 Face to Face Taskforce Meeting Annual NE STEMI Conference EMS/Hospital education Data Analysis and Quality Improvement Model sharing Public Media and Awareness campaign Sustainability Plan Development 18 Improving the System of Care for STEMI Patients
NE Mission: Lifeline Taskforce Engagement NE Misson: Lifeline Taskforce 2014-2017 Composition: All interested volunteers: Nurses/Nursing leaders, EMS Providers, Leadership & Medical Directors, Rural and Urban health care providers from Emergency medicine and Cardiology. Other medical professionals interested in improving emergency cardiovascular care in Minnesota. Time Commitment: 1 hr. bi-monthly teleconferences with annual face to face meeting Meeting Schedule: Bi-Monthly teleconference or Net Meeting the 3 rd Tuesday from 12:30 p.m. to 1:30 p.m. Central Time Task Assignment: Regional updates and sharing statewide on activities and efforts To volunteer to participate in committee work as needed throughout the project Improving the System of Care for STEMI Patients 19
M:L NE Meetings and Conferences Annual M:L Taskforce in person meetings Monthly Teleconferences Subcommittee meetings Annual NE STEMI Conference: Highlight NE successes and Lessons learned Hear from clinical experts about new science Network with peers to advance collaboration STEMI Survivor Celebration Recognize System excellence and award achievements Improving the System of Care for STEMI Patients 20
Hospital and EMS Discussion Where is your system in development of an internal STEMI protocol now? Is Pre-Hospital Activation of STEMI Response Team the standard of care at your facility, and what does that look like? o Identify Strategies for Success and/or real or perceived barriers How do we break down political barriers and develop a unified voice for NE? Improving the System of Care for STEMI Patients 21
PCI Referring Hospitals What does pre-hospital STEMI activation look like at your facility? Do you routinely call for the next leg of transfer prearrival? What are the greatest barriers in obtaining a door in- door-out of 45 min or less? What are the greatest barriers to obtaining a door to lytic administration time of < 30 minutes What are the greatest barriers to obtaining a door to ECG time of < 10 minutes? 22 Improving the System of Care for STEMI Patients
PCI Receiving Hospitals: What mechanism is your facility currently utilizing for STEMI Data Collection, Quality Improvement, Outreach and Feedback? What is the level of support for ACTION GWTG ARG Participation at your facility? What are the greatest barriers within your network to achieving a 90-120 min FMC to Primary PCI reperfusion in your area? Improving the System of Care for STEMI Patients 23
EMS What are the barriers to implementing pre-hospital 12 L ECG with a mechanism for field recognition and hospital pre-activation of STEMI patients? What do you think the greatest barrier will be in working with your local hospital and medical directors to developing pre-hospital STEMI identification method? Where are the greatest needs in training and understanding STEMI recognition and Prehospital activation among the EMS community? Improving the System of Care for STEMI Patients 24
Rural NE Mission: Lifeline www.heart.org/missionlifelinene 5/3/2015 25