4/30/2020 ©2011, American Heart Association 1

MISSION: LIFELINE EMS RECOGNITION

Mission: Lifeline EMS Recognition Updates Part 1 of 2

4/30/2020

Objectives for Today

• Review the EMS Recognition Measures • Discuss data collection strategies • Provide a brief update of the 2014 changes • Question & Answers ©2010, American Heart Association 4

Presenter/Panelist

Ben Leonard

Mission: Lifeline Director Casper, WY [email protected]

Mic Gunderson

Director of Clinical Systems Lakeland, Florida [email protected]

4/30/2020 ©2010, American Heart Association 5

EMS Recognition FAQ

4/30/2020 ©2013, American Heart Association 6

4/30/2020

Mission: Lifeline EMS Recognition Measures

©2011, American Heart Association 7

% 12 Lead ECG Acquired

MEASURE 1 – COLLECTING THE DATA

INCLUSION CRITERIA: • Denominator Number of Patients with c/c Non-Traumatic Chest Pain • Number of Patients that are 35 years of age or over • Numerator Number of the patients included in the denominator that had a Pre-Hospital 12 Lead ECG acquired Q1 Q2 Q3 Q4 4/30/2020 ©2011, American Heart Association 8

% FMC to Device Activation/Primary PCI < 90 Minutes

MEASURE 2 – COLLECTING THE DATA

INCLUSION CRITERIA • • •

Denominator

Number of Patients (18 years of age or over) with a STEMI noted on Pre-Hospital ECG AND Were transported to a STEMI Receiving Center AND Had Primary PCI Performed •

Numerator

Number of patients in the denominator where the total time from Pre-hospital FMC to Device activation/Primary PCI was achieved in 90 minutes or less 4/30/2020 ©2011, American Heart Association 9

% FMC to Device Activation/Primary PCI < 90 Minutes

MEASURE 2 – COLLECTING THE DATA REPORTING OUTLIERS/APPLYING EXCLUSIONS

Report the

number of patients

, included in the denominator volumes, where the total time from pre-hospital FMC to device activation/Primary PCI was more than 90 minutes.

Using the outlier volume, identify the number of patients that experienced one or more of the allowable exclusions:   Delay caused by patient or family providing consent for treatment/transport Delay caused by patient experiencing cardiac arrest and/or the need for intubation   Delay caused by difficulty in accessing femoral or radial artery (cath lab) Delay caused by difficulty in crossing coronary lesion (cath lab) 4/30/2020 ©2011, American Heart Association 10

% Arrival to Fibrinolytic Administration < 30 Minutes

MEASURE 3 – COLLECTING THE DATA

INCLUSION CRITERIA • • •

Denominator

Number of Patients (18 years of age or over) with a STEMI noted on Pre-Hospital ECG AND Were transported to a STEMI Referring Center AND Had Fibrinolytic Therapy Administered •

Numerator

Number of patients in the denominator where the total time from Arrival at the Referring Center to Fibrinolytic Administration was achieved in 30 minutes or less 4/30/2020 ©2011, American Heart Association 11

% Arrival to Fibrinolytic Administration < 30 Minutes

MEASURE 3 – COLLECTING THE DATA REPORTING OUTLIERS/APPLYING EXCLUSIONS

Report the

number of patients

, included in the denominator volumes, where the total time from Arrival at the Referring Center to Fibrinolytic Administration was greater than 30 minutes.

Using the outlier volume, identify the number of patients that experienced one or more of the allowable exclusions:   Delay caused by patient or family providing consent for treatment/transport Delay caused by patient experiencing cardiac arrest and/or the need for intubation 4/30/2020 ©2014, American Heart Association 12

•

Pre-hospital Impact on Fibrinolytic Administration

December 2013 ACTION Registry-GWTG Data shows – Only

44%

or less of the patients that receive Fibrinolytic Therapy do so in 30 minutes • When patients are transported from the field to a STEMI Referring Center, the events that occur in the pre-hospital environment affect the timeliness of care in the ED – Early identification of the STEMI via 12 Lead ECG • Completion of the Pre-Hospital Lytic Checklist •

IF patient is identified as Lytic Ineligible – consider by-pass of the referring center and transport directly to the STEMI Receiving Center (PCI Hospital)

– – – Early notification of the STEMI patient to the Referring Center Early ED preparation for STEMI patient’s arrival Early administration of Fibrinolytics (Lytics) 4/30/2020 ©2011, American Heart Association 13

Exclusions

• • • TRACKING EXCLUSIONS TIPS A patient may only be applied once in the exclusions – even if the patient meets more than 1 of the criteria The exclusions regarding delays in consent and the need for CPR and/or intubation can be used when these delays occur with EMS or when they occur after arrival to the destination center In the application, the achievement will be calculated with the excluded patients applied to the original denominator 4/30/2020 ©2011, American Heart Association 14

EMS Data Collection Workbook

Template for follow up data collection on patients treated and transported to a STEMI receiving Center or a STEMI Referring Center 4/30/2020 ©2013, American Heart Association 15

2015 EMS Recognition Updates

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Mission: Lifeline EMS Recognition Volume Requirements

• 4/30/2020 BRONZE: A minimum of 75% compliance for each required measure. o Volume: at least 2 STEMI patients per reporting quarter with at least 4 STEMI patients in the 2014 calendar year. ©2011, American Heart Association 17

Mission: Lifeline EMS Recognition Volume Requirements

• SILVER: Aggregated annual score achieving a minimum of 75% compliance for each required measure. o Volume: at least 8 STEMI patients in the 2014 calendar year. 4/30/2020 ©2011, American Heart Association 18

Mission: Lifeline EMS Recognition Volume Requirements

• 4/30/2020 GOLD: 2 calendar years achieving an annual Aggregate minimum of 75% for each required measure. o Volume at least 8 STEMI patients in the 2014 calendar year.

o Must have achieved a SILVER Award in 2014 ©2011, American Heart Association 19

2015 EMS Recognition Application (almost final – subject to change)

INDIVIDUAL APPLICATION • • • • No change from 2014 EMS agency/department acquires the 12 lead ECG AND Transports the patient to the destination hospital Applying agency name will be on the Award Certificate Applying agency must meet the volume criteria 4/30/2020 TEAM APPLICATION • • • • • Primary EMS Agency must complete the application Primary EMS Agency has the option to name any/all Medical First Responding agencies/departments that provide a coordinated response to the possible STEMI patients Applying agency name will be on the Award Certificate All Medical First Responder agencies/departments will also be included on the Award Certificate Applying agency must meet the volume criteria JOINT APPLICATION • • • Designed for agencies/departments where one agency acquires the 12 Lead ECG and a second agency either provides the transport to the destination hospital or provides the Paramedic to treat the patient The 2 agencies/departments must apply together in one application The volume criteria must be met with patients where the 2 applying agencies/departments treat the same patients ©2014, American Heart Association 20

2015 Mission: Lifeline EMS Recognition Timeline

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Lessons Learned (Per 2014 Post-Recognition Survey)

Sent to all agencies that achieved a level of EMS Recognition Why are we (EMS) held accountable for the PCI time? We (EMS) have no control over patient care once the patient is at the hospital.

• • • • • Mission: Lifeline – Looks at STEMI care from a SYSTEM perspective Dispatch Medical First Responders EMS (Air/911 and Interfacility) STEMI Recieving Centers STEMI Referring Centers 4/30/2020 2012 AHA Mission: Lifeline 22

• • • • •

EMS can AFFECT Care

Attend the STEMI Multidisciplinary Team Meetings – – – – Monthly or Quarterly Non-Punitive Collaborative and Supportive Provide Feedback to each other Collaborate with the hospital to look at process improvement opportunities Participate in Mock STEMI Drills Together with the STEMI Receiving Center – Develop a Pre-Hospital Activation Process Review Internal Data and present to the multidisciplinary team – – – Time of Call – Time of Arrival (Avg) Time of Arrival – Time of ECG Time of STEMI Identification – Notification at destination hospital 4/30/2020 2014 AHA Mission: Lifeline 23

Lessons Learned (Per 2014 Post-Recognition Survey)

Sent to all agencies that achieved a level of EMS Recognition We (EMS) had trouble getting the needed data from the hospitals • Relationships take time • Work to build the relationship between the STEMI Outreach Coordinator and your agency • Request 24-48 hour feedback on EVERY STEMI patient • Request to attend the Multidisciplinary Meetings • Request to be notified of any STEMI’s missed in the field • Request to collaborate on STEMI Identification Education for pre-hospital and ED personnel 4/30/2020 2014 AHA Mission: Lifeline 24

4/30/2020

Questions/Comments?

©2010, American Heart Association 25

Contact Information

Wyoming, Oklahoma and Texas Panhandle

Katie Butterfield [email protected]

Colorado

Julie Blakie [email protected]

New Mexico, El Paso and Lubbock

Stephanie Chapman [email protected]

Arkansas

Cammie Marti [email protected]

Central Texas and Rio Grande Valley

Diana Barrett [email protected]

Houston and Greater Gulf Coast

Kate Simpson [email protected]

Dallas/ Fort Worth Metro

Shanthi Raj [email protected]

Mid- Market/ Rural Texas

Cherie Boxberger [email protected]

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4/30/2020 Slides, audio and resources will be posted on www.heart.org/swaquality within one week of webinar.

©2011, American Heart Association 27