Transcript ACC GAP D2B - Chapter Affairs Extranet

GAP-D2B
An Alliance for Quality
GAP-D2B Goal
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To achieve a door-to-balloon time of </=
90 minutes for at least 75% of nontransfer primary PCI patients with STsegment elevation myocardial infarction
in all participating hospitals performing
primary PCI.
What is ACC doing to address
this issue?
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Assembled the ACC D2B Work Group
and (5) subgroups comprised of physician
and nurse volunteers and ACC staff
Summarized the evidence and identified
the evidence-based strategies
Currently developing the tools and
educational materials to support the
strategies.
Collaboration with strategically-related
organizations is being pursued.
Disseminating the “How”:
Evidence-based Strategies
1.Pre-hospital ECG to activate the cath lab
2.ED physician activates the cath lab
3.One call activates the cath lab
4.Cath lab team ready in 20-30 minutes
5.Prompt data feedback
6.Senior management commitment
7.Team-based approach
Themes
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Clear, explicit goal
Administrative support
Clinical champions
Data feedback
Systems approach
Collaborative teams
Culture
Circulation 2006;113:1079-85
Lowering door-to-balloon…a
how-to guide
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Patients presenting to the ED with CP are rapidly
triaged;
• an ECG is obtained and immediately shown to an ED
physician. Goal: Door to ECG<5 minutes.
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ED physician empowered to activate cath lab
• Interventionalist-does not have to wait until a
cardiologist sees the patient.
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24/7 staff and Interventional Cardiologist
coverage.
• Staff expected to arrive no later than 30
minutes after being called.
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ED staff trained in the expeditious
preparation of the patient.
• Adequate but limited assessment and
preparation performed.
• Orders standardized wherever possible (IV
access, groin shave, Reopro etc.)
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Transport to cath lab can occur even before
entire cath lab staff or cardiologist is present.
• When 2 out of 3 are there, “ready call” is made.
• Cardiologist will briefly assess patient at the door if
missed in ED.
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Limited injections of non-infarct related
arteries are taken with diagnostic catheters,
before proceeding directly to the culprit vessel
a with an interventional guide.
• LV gram and other imaging done at the end of case.
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Entire process is continually reviewed by a
collaborative committee consisting of :
• ED physician, Cardiologist, Cath lab staff,
Administrators, pre-hospital providers, nursing, etc.
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A subcommittee reviews charts on all cases with
door to device times of greater than 90 minutes,
and feedback is provided to those involved.
Transfers from outside hospitals are taken directly
to the cath lab, bypassing the ED and CCU.
Path Forward
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Disseminate the ‘How’ and recruit other
hospitals to develop similar programs
Focus on total door-to-balloon time
Focus on associated outcomes
Foster cooperation between PCI and
non-PCI hospitals to develop regional
MI systems and improve access
Public education to decrease symptomto-door time and use of 911
Challenges/Limitations
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Delays are common
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Relationship with outcome strong
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Disparity is hospital-based
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Time of day/day of week important
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Specialization important
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Pre-hospital ECG rare
Relationship between door to
balloon time and mortality in
NRMI registry
Door to balloon time (min)
<90
91–120
Mortality (%)
3.0
4.2
121–150
5.7
>150
7.4
McNamara RL et al. J Am Coll Cardiol 2006; 47:2180–2186.
Goals
National Time Goals
Centra Health Goals
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Door to ECG 5 minutes
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Door to ECG 5 minutes
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Door to Cath Lab 30 minutes
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Door to Cath Lab 30 minutes
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Door to Cath Lab device 55 minutes
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Door to Cath Lab device 25 minutes
Total =90 minutes
Total =60 minutes
Total Door-to-Balloon Time
Circulation 2005;111:761-7
LYNCHBURG GENERAL HOSPITAL
(ID #6311006)
Median (min)
Time from Arrival to Primary PCI
100
90
80
70
60
50
40
30
20
10
0
1st Qtr 2005
2nd Qtr 2005
Hospital
3rd Qtr 2005
Like Hospital
4th Qtr 2005
Nation
LYNCHBURG GENERAL HOSPITAL
(ID #6311006)
PCI within 90 min (%)
PCI Received within 90 Minutes of Hospital Arrival
100
90
80
70
60
50
40
30
20
10
0
1st Qtr 2005
2nd Qtr 2005
Hospital
3rd Qtr 2005
Like Hospital
Nation
4th Qtr 2005
Why pursue D2B at this point?
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ACC physicians, staff and our strategic
partners are working together on GAP-D2B.
ACC Governor survey indicates that D2B is
one of the top areas of interest.
GAP-D2B is consistent with ACC-AHA and
SCAI Guidelines.
Opportunity for the ACC BOG to exert its
leadership by beginning the launch of a
national quality improvement initiative.
Achieving the D2B goal will have a
significant positive impact on patient
outcomes and mortality.
How will ACC execute a
solution?
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Recruitment begins NOW WITH YOU!
The formal “launch” will occur in November
2006 at AHA.
Over 130 hospitals have already expressed
interest in this national collaborative.
GAP-D2B website will enable participants to
post data, communicate and evaluate best
practices.
ACC Work Group developing tools and materials
necessary to successfully reduce door-to-balloon
time.
What is asked of hospital
participants?
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Commit to implementing the evidence-based
strategies.
Commit to submission of your data.
Allow ACC to use hospital name in D2B
promotional materials.
Help contribute to community by sharing stories,
successes and obstacles.
Learn from others.
No cost to join.
Role of Chapter Executives
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Establish a Chapter Quality Council.
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Work with Governor to convene D2B team.
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Coordinate Chapter level activities and
communications.
Assist Governor in recruitment and follow
up.
Role of Governors
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Identify physician champions in your state
Work with physician champions to recruit your primary
PCI hospitals to GAP-D2B
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Contact your local QIO for collaboration potential
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Contact your local MCOs for collaboration potential
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Email information to [email protected]
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WE CHALLENGE EACH GOVERNOR TO
RECRUIT AT LEAST 4 HOSPITALS BY NOV. 1