Time is muscle

Minot, ND June 16th , 2014

“IN GOD WE TRUST; ALL OTHERS MUST BRING DATA.”

W. EDWARDS DEMING(THE DEMING CYCLE – PDSA)

1. The National Cardiovascular Data Registry (NCDR®) is the American College of Cardiology’s suite of data registries

2. ACTION Registry®–GWTG™ (ARG) is a risk-adjusted, outcomes-based quality improvement program that focuses exclusively on high-risk STEMI/NSTEMI patients

3. Mission Lifeline STEMI specific data is compiled by Duke Clinical Research Institute (DCRI)

Data Collection

3 Reports are Generated from Abstraction into ACTION Registry - GWTG

1. ACTION Registry- GWTG Report

2. M:L Receiving Center Report

3. M:L Regional Report

M:L Composite Score

MeasureQtr. 4 % Qtr. 1 % Qtr. 2 % Qtr. 3 % Qtr. 4 %

2012 2013 2013 2013 2013

M:L Composite Score 95.7 97.6 96.5 97.3 98.2%

Time to Primary PCI <= 90 min. 92.5 91.5 98.1 100 94.3%

M:L First Medical Contact to Primary PCI <=90 50 78.6 66.7 73.7 72.2%

Reperfusion Therapy 93.9 95.9 93.3 Removed X

Aspirin on Arrival 100 100 100 97.6 100%

Aspirin at Discharge 99.2 99.1 99.1 100 100%

Beta Blocker at Discharge 98.4 99.1 98.2 96.1 98.4%

Statin at Discharge 99.2 100 99.1 100 100%

ACE/ARB for LVSD at Discharge 86.7 90.9 90 83.3 100%

Adult Smoking 97 100 98.1 98.1 100%

M:L Composite Score

Qtr.4, 2012

Qtr. 1, 2013

Qtr. 2,2013

Qtr. 3, 2013

Qtr. 4, 2013

Median Time from Symptom Onset

To First Medical Contact (mins) 57 40 38.5 42 44

To Arrival via POV (mins) 84 78 74 86 69

Arrival Mode

EMS 41% 43% 46% 42% 49%

POV 56% 53% 52% 55% 50%

Mobile ICU or Air 3% 3% 2% 4% 1%

Symptom Onset to Arrival

Measure Qtr. 2, 2012 Qtr. 1 , 2013 Qtr. 2, 2013 Qtr. 3, 2013 Qtr. 4, 2013

ND Nation ND Nation ND Nation ND Nation ND Nation

% % % % % % % % % %

First ECG obtained Pre-

Hospital (EMS Arr.) 73 70 74 70 79 71 83 72 89 73

STEMI Noted on first ECG 94 87 92 86 91 86 91 86 87 86

Reperfusion Method

Primary PCI Overall 73 85 72 85 73 85 73 85 70 85

Direct Presentation 89 90 92 90 90 90 93 90 94 90

Transfers In 60 73 58 74 60 74 58 74 51 75

Fibrinolytics 23 6 25 6 24 6 25 6 27 5

Direct Presentation 1 1 1 1 1 1 1 1 0 1

Transfers In 40 19 43 19 42 19 44 18 47 18

Measure Qtr. 2, 2012 Qtr. 1 , 2013 Qtr. 2, 2013 Qtr. 3, 2013 Qtr. 4, 2013

ND Nat ND Nat ND Nat ND Nat ND Nat

Min Min Min Min Min Min Min Min Min Min

Median Time from FMC to Primary PCI (min) Non-Transfer-In

83 82 77 82 77 82 81 82 76 81

Median Time from FMC to Primary PCI (min) Transfer-In 149 138 164 139 165 140 165 139 167 137

Median length of stay (min.) referral facility

76.5 60 80 60 78 60 75 60 78 59

A System of Care

System

1. Multidisciplinary team meetings that include EMS, non-PCI hospitals/STEMI

Referring Centers, and PCI hospitals/STEMI-Receiving Centers to evaluate

outcomes and quality improvement data. Operational issues should be

reviewed, problems identified, and solutions implemented.

2. Each system should have a recognized system coordinator, receiving and

referring hospital champions, and an EMS medical director/champion.

3. At least one of each system components (EMS, STEMI Referring Centers

and STEMI Receiving Centers) should meet the appropriate participating

criteria.

Thank You For all you do to save lives and change lives!