Multidisciplinary Process Improvement Building Relationships

Multidisciplinary Process Improvement Building Relationships

Mission: Lifeline - Relationships Improved Outcomes Presented by: Lori Hollowell, BSN, RN National Quality Systems Improvement Consultant, Mission: Lifeline and ACTION Registry-GWTG NO Disclosures 7/31/2014 2010, American Heart Association 2

What is Mission :Lifeline? Mission: Lifeline is the American Heart Association s national initiative to advance the systems of care for patients with ST-segment elevation myocardial infarction (STEMI) and those resuscitated after experiencing an Out-of-Hospital Cardiac Arrest. The overarching goal of the initiative is to reduce mortality and morbidity for STEMI and Out of Hospital Cardiac Arrest patients and to improve their overall quality of care 7/31/2014 2010, American Heart Association 3

How Have We Done These Things? And How Can The Systems Continue to Improve? = IMPLEMENTATION REGIONALIZATION OPTIMIZATION

We Know: Where Delays Occur THE PATIENT REFERRAL CENTER TRANSPORT RECEIVING CENTER Unfamiliar with signs and symptoms of a heart attack Denial Slow to activate 911 EMS System Arrives by POV (Personal Owned Vehicle) Identification of STEMI patient Triage Protocols Access to 12 Lead ECG Machines Diagnostic Dilemma Unavailability Weather Delay in arrival to Referral Center Pumps and Drips Patient Records from Referral Center Transport Distance Acceptance Delay STEMI Alert call Delay Cath Lab Team Delay Patient Condition Arrest/Shock Transport Notification Transfer Acceptance Patient Condition Arrest/Shock 7/31/2014 2012, American Heart Association 5

We Know: Why Delays Occur NON-MODIFIABLE MODIFIABLE WITH DIFFICULTY MODIFIABLE Distance to STEMI Receiving Center Geography Patient/Public Awareness Corporate Loyalty Market Share Preferred Provider Transport Agreements PCI Cardiology On-Call Scheduling Non-Invasive Cardiologists on call Low Clinical Staffing Structure Budgetary Issues (Access to Equipment) Lack of Triage Protocols No Pre-Planned Reperfusion Strategy Lack of Printed Transfer Plan Lack of Back Up Transfer Plan Fear of Lytic Administration NTG and Heparin drips are started Needed Education (EMS and Hospital) All employees are not aware of STEMI protocols Lack of Data Collection Communication/Relationships 7/31/2014 2012, American Heart Association 6

Ideals and Mission: Lifeline Criteria to Support Timely Reperfusion Strong Multidisciplinary Teams Relationship Building between EMS and ED EMS Point of Entry/ Transport Destination Protocols based on data Data Collection and Sharing between Receiving Center and EMS Communication and Understanding of ACC/AHA Guidelines Early 12 Lead ECG Acquisition Early STEMI Receiving Center notification of 12 Lead ECG findings Early Activation of Cath Lab Team Consider lytic administration at Referral Centers 7

Relationship + Communication = Coordinated Care Feedback Right Here/ Right Now 24-48 Hours Retrospective Education EMS to Hospital Hospital to EMS Joint event Recognition Job Well Done Little Things Mean A LOT!! 7/31/2014 2011, American Heart Association 8

FMC to Reperfusion THE BEST IT CAN BE Point of Entry and Pre-Hospital Activation Protocol Adherence to ACC/AHA STEMI Guidelines Strong Multidisciplinary Multiagency Team EMS ED Relationship

EMS ED Relationships 7/31/2014 2011, American Heart Association 10

EMS Providers Very Independent Smart Autonomous Resourceful Selfless Compassionate Know their roles Territorial Type A ED Staff Very Independent Smart Selfless Autonomous Resourceful Compassionate Know their roles Territory Type A VERY 7/31/2014 2011, American Heart Association 12

EMS ED Relationships DESTINATION TRANSPORT DECISIONS TIMELY APPROPRIATE TREATMENT IMPROVED PATIENT OUTCOMES

1 - Patient Outcomes Feedback Promotes Transparency Shares Ownership Promotes Excitement Promotes Healthy Competition 7/31/2014 2011, American Heart Association 14

Data Collection and Sharing between EMS and STEMI Receiving (and Referral) Center - FEEDBACK EMS Retrospective Incremental Times throughout FMC to Device Process 24 48 Hours D2B Overall Door to Lytics Right Here Right Now Identification of TRENDS over time Culprit Artery(ies) Door In Door Out STEMI No STEMI

Right Here Right Now

Right Here Right Now Clear concise radio comms (On both ends) 2 Way Radio = Ability to ask questions and clarify in both directions ECG Transmission Reception Process Body Language ED Readiness to accept patient EMS Run Report Provides valuable data for overall process improvement Invite EMS providers to go to Cath Lab with the patient if they have the time? 7/31/2014 2011, American Heart Association 18

24 48 Hour Feedback How did we really do with this one? 7/31/2014 2011, American Heart Association 19

USE This Data!! Opportunities to improve Consistency in care 7/31/2014 2011, American Heart Association 20

Retrospective Feedback Multidisciplinary Team Meetings Receiving Center Representatives ED Leadership Cardiology Radiology Cath Lab Registration Administration Referral Center Representatives EMS Representatives Survivors/Public 7/31/2014 2011, American Heart Association 21

Retrospective Feedback COLLECT AND REVIEW INCREMENTAL COMPONENTS OF OVERALL FMC Notify Depart ED to Cath Lab PCI Arrival ECG STEMI Alert Arrival to ED 7/31/2014 2011, American Heart Association 22

DATA TO REVIEW WITH A MUTIDISCIPLINARY TEAM Pre-Hospital Data S/S to 911 Call 911 Call to EMS Arrival EMS Arrival to FMC FMC to ECG ECG to ED Notification ED Notification to ED Arrival Hospital Data EMS Notification to STEMI ALET STEMI ALERT to ED Arrival STEMI ALERT to Cath Lab Call In ED Arrival to ED Transfer Out ED Out to Cath Lab Arrival Cath Lab Arrival to Device Activation

AHA Quality Improvement Specialists Mission: Lifeline Implementation Provide M:L Reports using AR- G data ACC M:L Reports Keeper of AR-G Data Operational Support for data upload Executes Data Release Consent Forms Analyze the AR-G data using logic specific to ACTION reports Posts AR-G and M:L Reports DCRI Analyze the AR-G data using logic specific to M:L 7/31/2014 2011, American Heart Association 24

Mission: Lifeline Reports Utilize ACTION Registry-GWTG Data Report data on STEMI patients only (AR-G captures NSTEMI and STEMI data) Are available in PDF form (not available in Dashboard Format) AR-G Data Definitions are provided by ACC/NCDR Mission: Lifeline Data utilizes data entered in AR-G Limited/Premier Form AR-G Data element Sequence Numbers are used to prepare the logic for the reported M:L Data 7/31/2014 2011, American Heart Association 25

RESOURCES WWW.NCDR.COM WWW.HEART.ORG/MISSIONLIFELINE

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Mission: Lifeline Receiving Center Reports M:L Receiving Recognition Measures Door to Device < 90 Minutes FMC to Device < 90 Minutes ASA within 24 hours of arrival ASA at discharge Beta blocker at discharge Statins or lipid lowering drugs for patients with LDL >100 ACEI/ARB at discharge for patients with LVSD Smokers with smoking cessation counseling at discharge 28

PLUS Measure/Award- Additional award level for STEMI Receiving Centers Must meet a baseline Mission: Lifeline award level AND Achieve 1 st Door to Device < 120 Minutes (75%) Transfer for PCI only 29

M:L FMC to PCI Data 30

FMC to PCI page 1 Data and Page 9 Data 31

First ECG Obtained Pre-Hospital 32

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Mission: Lifeline Referring Center Reports M:L Referring Center Recognition Measures Door to ECG < 10 Minutes Door In Door out <45 Minutes (transfer for PCI) ASA before transfer or before ED discharge ASA on discharge Beta Blocker at discharge Statins or lipid lowering drugs for patients with LDL >100 ACEI/ARB at discharge for patients with LVSD Smokers with smoking cessation counseling at discharge 34

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Mission: Lifeline Regional Reports show hospital data compared to other hospitals in a specific geographical region 36

Consistent Regional Retrospective Feedback MultiFacility Team Meetings - Quarterly Set Regional Goals Share Best Practices Provide Professional Support Promotes Healthy Competition 7/31/2014 2011, American Heart Association 37

2 Education/Protocol Development STEMI Identification 101 STEMI 102 Imposters STEMI Regionalization EMS Invite ED/Hospital Staff to your house Ride A Long Program for Hospital Administration/ED Leadership ED MD/Cardiologist speaker Retrospective Feedback Road Show 7/31/2014 2011, American Heart Association 38

What is a STEMI? BAMMMMMMMMM!!! 39

Educate : One STEMI at a Time 7/31/2014 2011, American Heart Association 40

Collaborative Education Forums STEMI Identification Interventional Stroke Care Hypothermia

ED and EMS Combined Educational Events

Community Education Community CPR Events Shared Tents at Local Festivals Collaborative Healthy Lifestyle messaging at churches Child Safety Fairs

3 Recognition Of A Job Well Done 7/31/2014 2011, American Heart Association 44

STEMI Of The Month Club

Out of Hospital Cardiac Arrest Survivor Ceremony 7/31/2014 2011, American Heart Association 46

4 The Little Things Cold Soda Hot Coffee Small Snacks Place to sit Computer/Printer Access 7/31/2014 2011, American Heart Association 47

Off Site Events

Pre-Hospital Data/ Run Report Hospitals NEED EMS Data Pre-Hospital Times = The FIRST Chapter of the Book

Relationship Growth Customer Partner Team Professional Personal Positive Change Mutual Respect Protocols New and Revisions Improved Systematic Response (Not Just STEMI) Improved Patient Outcomes Improved Communications Improved Relationships 7/31/2014 2011, American Heart Association 50

Maintaining EMS-ED Relationships 7/31/2014 2011, American Heart Association 51