Transcript SHN AMI national call Ontario Feb0508

National AMI Information Call
February 5, 2008
Patient Safety Initiative
Elements of AMI bundle
•
•
•
•
Early administration of aspirin
Aspirin at discharge
Beta-blocker at discharge
ACE-inhibitor or angiotensin receptor
blocker at discharge
Elements of AMI bundle
• Timely reperfusion (thrombolysis or
percutaneous intervention)
• Smoking cessation counseling
Today’s focus:
• Issues and opportunities related to
capturing and improving the timing of AMI
care at the receiving hospital and the
tertiary PCI centre
Southlake Regional Health Centre
• 323 bed hospital in Newmarket, Ontario
• Regional Cardiac Care Program
• Advanced services: Interventional
Cardiology, Cardiac Surgery and Heart
Rhythm Programs
Successful strategies to improve AMI
and timely PCI
• Early repatriation of PCI patients back to referring hospitals
• Increased availability of cath lab and interventional team
(expanded working hours)
• Regional PCI guidelines developed and disseminated to regional
partners
• Primary PCI implemented within SRHC
Successful strategies to improve AMI
and timely PCI
• Implementation of regional STEMI bypass program
• Dedicated data analyst for PCI data
• Ongoing collaboration with our own ER department and with
regional partners
Challenges
•
•
•
•
•
Number of advanced vs. primary paramedics in region
Cost of equipment: technology to transmit ECG’s from ambulance
Cath lab in use
Bed availability and patient flow
Efficient use of PCI unit
D
ov
20
ec 05
2
Ja 00
n 5
2
F 00
eb 6
2
M 00
ar 6
2
A 00
pr 6
2
M 00
ay 6
2
Ju 00
n 6
20
Ju 06
l2
A 00
ug 6
2
S 00
ep 6
2
O 00
ct 6
2
N 00
ov 6
D 200
ec 6
2
Ja 00
n 6
2
F 00
eb 7
2
M 00
ar 7
2
A 00
pr 7
2
M 00
ay 7
2
Ju 00
n 7
20
Ju 07
l2
A 00
ug 7
2
S 00
ep 7
2
O 00
ct 7
2
N 00
ov 7
D 200
ec 7
2
Ja 00
n 7
2
F 00
eb 8
2
M 00
ar 8
2
A 00
pr 8
2
M 00
ay 8
2
Ju 00
n 8
20
08
N
Percentage
AMI
7.0 Perfect Care for AMI
120%
100%
80%
60%
40%
20%
0%
Month
Actual
Goal
The Credit Valley Perspective
• Credit Valley
Hospital is a 383 bed
community hospital
• 360 patients
admitted with acute
myocardial infarction
(AMI) in 2006/2007
AMI Data
• 139 subendocardial myocardial
infarctions admitted
• 113 admitted to CCU
• 102 transferred to other facility for
coronary intervention
In the Beginning…
•
•
•
•
EFFECT study (1999-2004)
Retrospective chart review of AMI patients
135 charts audited
Quality indicators included risk factor reduction, ‘door
to needle time’, aggregate secondary prevention
(ICES/CCORT, 2004)
EFFECT Study
• Current practice in the ER is to use preprinted physician orders and the A.C.T.
team for all AMI patients
PCI or TnK??
• No percutaneous coronary intervention facility on site
at Credit Valley Hospital for primary PCI
• Treatment delays a risk when transferring to other
facility for primary PCI
• Pharmacotherapy the best choice for STEMI patients
• Facilitated PCI (TRANSFER-AMI)
STEMI Data 2007 (Jan to June)
• SHN goal 85% of patients with door to needle time < 30
min
• Average time for January 2007 to June 2007 was 37.4
minutes (median 28.5)
• 54% of CVH patients had door to needle time < 30 min
Challenges…
• Time to ECG
• Changing cardiac patient population
• Transportation issues
Opportunities
• Regionalized care for AMI patients requiring
interventions
• Improved transfer protocols with an organized, patient
centered focus
• Enhanced communication and documentation
Questions?
Thank you for your interest in
SHN!
Amanda Darwood RN BSc , Southlake Regional Health Centre
Rachel French RN, Credit Valley Hospital