door to needle time

Download Report

Transcript door to needle time

Presenter

Chris Bjerke, BSN, MBA

National Director, Mission: Lifeline for the American Heart Association

Disclosures

•

I have not financial disclosures or conflicts of interest

ST Elevation Myocardial Infarction (STEMI)

• Early diagnosis and rapid reperfusion therapy for ST segment myocardial infarction (STEMI) limits infarct size and improves survival • Current guidelines recommend reperfusion therapy within 90 minutes of first medical contact and within 120 minutes for hospital transfers • Door-to-balloon is <90 minutes in 95% of cases (non transfer) in ACTION Registry ® - Get With The Guidelines™ • Door-to-balloon time for transfers occurs <90 minutes 33% of the time and <120 minutes 66% of the time in ACTION Registry ® - Get With The Guidelines ™ • Delay in symptom onset to treatment increases mortality 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction.

Circulation.

2013;127: 3

Pre-hospital ECGs

• • Pre-hospital electrocardiograms (PH ECG) have been shown to decrease door-to-balloon times (DTB) and first medical contact-to-device times. Over 60% of STEMI patients receive a PH ECG, yet they fail to be integrated into systems of care to decrease total ischemic time.

• 60% of STEMI patients call EMS for transport.

• Use of EMS transportation is associated with substantial reductions in ischemic time and treatment delays.

• Community education efforts are needed to improve the use of emergency transport as part of system wide strategies to improve STEMI reperfusion care.

Use of Emergency Medical Service Transport Among Patients With ST-Segment –Elevation Myocardial Infarction Findings From the National Cardiovascular Data Registry Acute Coronary Treatment Intervention Outcomes Network Registry –Get With the Guidelines

Robin Mathews, MD; Eric D. Peterson, MD, MPH; Shuang Li, MS; Matthew T. Roe, MD, MHS;

(Circulation. 2011;124:154-163.)

Protocol for Paramedics to Recognize and Activate STEMI in the Field

• PH ECG interpreted by EMS paramedics • Activation of the catheterization laboratory in the field • Bypass ER and admitted directly to catheterization laboratory for clear STEMI & hemodynamically stable

Value of EMS Recognition

• • • Quality improvement – – – – To Improve efficiencies for patient care Early recognition of STEMI Early hospital alert Reduced total ischemic time (System onset to Device) Hospitals Integration – Streamline care - Reduce handoffs - Bypass hospitals without PCI capability when applicable – Improve feedback processes Expansion of Scope of Practice – Destination Protocols – EMT provisions for ECG Acquisition & Transmission currently against many state mandates 4/29/2020 ©2013, American Heart Association 7

• •

EMS Agenda for the Future

The EMS Agenda for the Future

is a strategic plan and needs assessment to guide the development of Emergency Medical Services (EMS) into the twenty-first century. The Agenda examines what has been learned during the past three decades and creates a vision for the future of EMS.

As EMS systems continue to look for ways of delivering emergency critical care in a more cost effective and efficient manner, there are several initiatives that should be considered to strengthen the EMS team. These include: – – – – Expand the role of EMS in public health and prevention. Involve EMS in community health monitoring.

Integrate EMS with other health care providers and provider networks.

Be cognizant of the special needs of the entire population.

•

Challenges Specific to AHA EMS Recognition

Focus on Quality

– New Formal Process – – – Previously seen as low priority QI processes are foreign concepts/practices to most agencies Culture change •

Data Collection

– Self Reporting Expectation •

System Fragmentation

– Competition of Services – – – Continuum of Care Patient Documentation Protocol Diversity & Equipment Variability 9

Why EMS Recognition?

To expedite care for STEMI patients where “Time is Muscle”

4/29/2020

Guideline based

Achievement Measures

• Percentage of patients with non traumatic chest pain, ≥ 35 years, treated and transported by EMS who get a pre-hospital 12-lead electrocardiogram • Percentage of STEMI patients transported directly to a STEMI receiving center, with

first (pre-hospital) medical contact to device time

 90 minutes • Percentage of lytic eligible STEMI patients treated and transported to a referring hospital for fibrinolytic therapy with a

door to needle time

How Can EMS Affect Door to Needle Time?

• Early Activation for positive STEMI on 12 Lead ECG • Reperfusion Checklist completion on patients who will be transported to a Referring Hospital (Non PCI capable) 4/29/2020 ©2013, American Heart Association 12

2014 Data Submission Timeline

DATA SUBMISSION

• • January 1, 2014 – February 28, 2014 Submit summary of quarterly data covering Q1-Q4 of 2013

DATA REVIEW

• • March 1, 2014 through May, 2014 Data summary submissions will be reviewed by National Center Mission: Lifeline Personnel

RECOGNITION AWARDS

Recognition Awards

• • •

RECOGNITION BENEFITS

Certificate Press Kit • • • Media press release templates Icons for websites or other use Pre-made advertisement template Additional materials will be made available for purchase: • Examples: Pins, Patches, Decals for Ambulances and Trucks (Gold only) 4/29/2020 ©2013, American Heart Association 15

Data Collection and Submission

• • • • •

DATA SUBMISSION PROCESS AND TIMELINES

One time annual application via

free

online EMS Recognition Application tool Continuous data collection occurs independently of the Mission: Lifeline application tool Worksheets for inclusion / exclusion criteria will be available Online EMS recognition application tool available January 1 – February 28 th for quarterly summary data submission.

Award notifications will be distributed beginning in Mid-April through June, 2014 4/29/2020

January 1, 2013 – December 31, 2013

Data reporting period

January 1, 2014 – February, 28 2014

Data submission available for award application

March 1, 2014 – Mid April, 2014

Mission: Lifeline Review of award applications

Mid April, 2014 – June 2014

Stay Connected

•

FACEBOOK

www.facebook.com/AHAMissionlifeline •

MISSION: LIFELINE NETWORK – EMS CENTRAL

http://MLnetwork.heart.org/EMS •

MISSION: LIFELINE HOMEPAGE AND RECOGNITION SITE

From the American Heart Association Mission: Lifeline ® Team: