Presented by: Jen Ewing, Denise Damore, Rob Dowling and Kelly Trieglaff

Presented by: Jen Ewing, Denise Damore, Rob Dowling and Kelly Trieglaff

How we Started? Who is involved? What was our process? What has happened? Where we are now? How you can help?

Primary Stroke Centers Primary Stroke Center recommendations by the Brain Attack Coalition in 2000 and updated in 2011 address the vital role the EMS have in the chain of survival for patients with stroke Primary Stroke Centers must cooperate and communicate with inbound EMS Primary Stroke Centers are required to meet standards for EMS pre-hospital stroke care Jama, volume 283, number 23, june 21 2000 Stroke, 2011, and Stroke 2007

Primary Stroke Centers Example: Joint Commission s requirements for Primary Stroke Centers includes EMS to have complete treatment guidelines for pre-hospital personnel. Communication with inbound EMS for the activation of the acute stroke team within the ED. Pre-hospital stroke assessment tool

Primary Stroke Center Goals Limit the disabilities of stroke Strengthen the relationship of the Emergency Department and EMS Same language for pre-hospital stroke assessments

Rob Dowling,BA, EMS PI dir.: St Anthonys:CP Tom Fentress: EMS ED coordinator: Methodist Bob Boby: EMS Coordinator: St. Marys: Hobart George Schulp: Superior Education Director Denise Damore: Superior EMS Manager Emery Garrick: EMS Methodist Lauren Hansen,RN, EMS coordinaotr, St Marg. Pat Pease, Laporte EMS Teri Youngman, Laporte EMS Coordinator

Jennifer Ewing, MSN, RN: Community Hospital Sherry Mosier, BSN, RN: Methodist Kari Kersettler, BSN, RN: St. Anthony, CP Kim Sgouroudis, BSN, RN: St Marys Julie Adaczyk-McCrea, MSN, RN: St Margaret:Dy Tracy Nix: St Anthony: MC Jill Conner, Neuro Director: Munster Jill Phelps: RN, St Catherines Nicole Stevens: RN, Porter Hospital

St. Mary s Medical Center: Hobart IU Health: Laporte Hospital: Laporte, In Franciscans: St Anthony s : Michigan City, In Franciscans: St Anthony s: Crown Point, In Franciscans: St. Margaret: Hammond, Dyer, In Methodist Hospital: Gary, Merrillville, In Community Hospital: Munster, In St Catherine's Hospital: East Chicago, In Porter Hospital: Valparaiso, In

Superior Ambulance Prompt Ambulance St. John Fire Sherrill Ville Fire Crown Point EMS La Porte EMS Gary EMS Porter EMS

Is the form user friendly to EMS? Did EMS find the form helpful when calling brain attack or stroke alert? Did the nurses use the form to obtain key TTT info? Did stroke coordinators find it useful to obtain key prehospital info?

EMS Training Officer Education Conducted during monthly QI Meeting Training officers educated staff over 30 day period. Re evaluated training status at next QI Meeting Go Live over 60 day period then re evaluated. Departments Involved Schererville FD, Crown Point Fire/Rescue, Saint John Fire Department

Average of 75-80 percent compliance with Brain Attack by EMS in 2013. 85 percent compliance achieved during 30 day educational period. Maintained 90 percent compliance during 60 day evaluation period. Form itself utilized for reference purposes.

Crews were slow to catch on/unsure of the purpose Where do we place the completed forms? Initially, concerns with more paperwork to complete ALS vs BLS with compliance/participation

Reminders of important assessment details Condensed form of information for radio report Consistent reporting of stroke symptoms from the field Ability to hand hospital staff information immediately. Information on form is useful for PCR

Signatures of crew members FAST check boxes -either Normal or Not Normal

Best Practice Pilot Stroke Center

Initial implementation Reach out to EMS - tool and expectations Education for staff in the ED Tracking method for using the tool

Evaluated after 3 months Established additional interventions Reach out again to EMS utilized EMS report room to post form and info Focus education on ED staff charge nurses, EMS coordinator Follow up provided by EMS coordinator Continue tracking form use

Start of pilot 67% compliance of overall run reports on chart from EMS provider 12% compliance at the end of the first month using form overall compliance of run reports 77% 35% compliance at end of month three using form Overall compliance of run reports 83% As of January EMS run report compliance was 97% and using the form 55%

Time to treatment reduction Better EMS stroke alert calls Emergency physician trust Stroke Coordinator ability to abstract field info easier. Partnering with CADI?????