Collaboration Between the ED and the Local Fire Department Improves Results, Saves Lives

An EmCare® Case Study

Methodist Richardson Medical Center Richardson, Texas

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ContentsIntroduction................................................................................................................ 2Challenge ..................................................................................................................... 2Solution ........................................................................................................................ 2Results ........................................................................................................................... 3A Case Sample ........................................................................................................... 4About EmCare®.......................................................................................................... 5 Contact EmCare ........................................................................................................ 6

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IntroductionMethodist Richardson Medical Center (MRMC), a non-profit hospital in Richardson, Texas, has offered compassionate medical, surgical and behavioral health services for more than 40 years. MRMC has received numerous recognitions and accreditations, including:

• SleepDisordersCenteraccreditedbyAmericanAcademyofSleepMedicine

• CancerCenteraccreditedbyAmericanCollegeofSurgeonsCommission on Cancer

• AdvancedPrimaryStrokeCenterdesignationbyAmericanStrokeAssociation

And, recently, the EmCare-affiliated emergency department at MRMC in Richardson, Texas became one of only a few in the Dallas area to be named a Cycle III Chest Pain Center and Heart Failure Center- the highest level of accreditation by the Society of Chest Pain Centers.

ChallengeEvery day in Dallas County, approximately 30 people suffer a heart attack and depend on the seamless delivery of emergency medical services to increase their chances of survival and quality of life. Cardiovascular disease is the number one killer of all Americans and current survival rates in Dallas County are lower than the national average. Response times vary across hospital systems and EMS providers, and that critical time can mean the differences between life, death and permanent disability.

“It is the time of reduced blood flow to the heart that counts, not just the time the patient arrives at the hospital,” says Dr. Nhan Nguyen, interventional cardiologist and medical director of Cardiology at MRMC.

The hospital had two goals: to improve results for those who suffered heart attacks in the region and to earn accreditation as a Chest Pain Center and Heart Failure Center. To achieve this status, hospitals must meet or exceed a comprehensive set of stringent heart failure care criteria and undergo an on-site evaluation by members of the Society of Chest Pain Centers review team.

SolutionTo ensure the medical center met the survey criteria, Dr. Elizabeth Fagan, EmCare Regional Medical Director, and Medical Director Dr. Brian Kenjarski

Every day in Dallas

County, approximately

30 people suffer a heart

attack and depend on

the seamless delivery

of emergency medical

services to increase their

chances of survival and

quality of life.

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The hospital works closely

with Richardson Fire

Department to improve

emergency services to the

surrounding community.

partnered with all of the hospital departments involved in the care of heart failure patients and standardized order sets to ensure appropriate treatment and documentation. The medical center also developed risk stratification tools to ensure patients are appropriately placed in either an observation bed or inpatient bed.

“The survey is very intense as the survey team evaluates every facet of your program,” said Dr. Fagan, who has also served as the emergency department medical director at MRMC. The survey included a review of the medical center’s involvement in EMS education, ED evaluation and treatment, inpatient care, discharge planning, patient education, community outreach, process improvement and other areas.

Through a multi-million dollar grant initiative between the American Heart Association (AHA) and W.W. Caruth, Jr. Foundation, efforts are being made to streamline protocols between participating hospitals and EMS agencies in a collaborative effort to reduce response times, increase action and coordinate data transfer. Every second counts and critical seconds are gained when effective coordination occurs.

As part of the efforts to prepare for the survey and to improve emergency services to the surrounding community, the hospital worked closely with the Richardson Fire Department. Dr. Fagan stated that, in this case, working with local EMS providers was crucial to meeting evaluation criteria. “Partnering with EMS allowed us to educate all providers who take part in the care of our community’s heart failure patients, from 9-1-1 call to discharge,” she said.

ResultsIn February 2011, the EmCare-affiliated emergency department at Methodist Richardson Medical Center received Heart Failure Accreditation from the Society of Chest Pain Centers. It is the twenty-sixth facility in the United States and the first in Dallas to receive the certification.

On Wednesday, August 24th Methodist Richardson Medical Center and the Richardson Fire Department were recognized for having the fastest total combined patient treatment time for data submitted to the AHA Dallas Caruth Initiative during 1st Quarter, 2011.

Specific initiatives of the program include convening EMS and hospital emergency providers to regionally standardize emergency heart attack treatment and transport protocols, report and share patient care and quality improvement data, increase professional education standards and

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eliminate equipment gaps so all EMS providers can identify suspected heart attack patients in the field and transmit to the hospital for expedited transport and treatment.

Dr. Fagan believes the certification should provide benefits to both the medical center and the patients for whom care is provided. “Early identification, prompt treatment and aggressive patient education will improve the care we can provide to our patients and decrease their readmission rate,” she said.

The process is relatively simple:

• Thepatientispickedupbyanambulancetobetakentothehospital

• RichardsonEMSpersonnelevaluatethepatientandifSTEMIpresents,they field-activate the cath lab

• Uponarrivalatthehospital,thepatientistakenthroughtheERwhereemergency medicine physicians can treat the patient on the way to the cath lab if needed

• Inthecathlab,cardiologistandhospitalteamperformaheartcatheterization and place a stent in the patient’s blocked artery

• Oncethepatienthasbeencatheterized,heorsheismovedtoahospital room until discharge

“Patients who recognize heart attack symptoms and quickly call 911 can be treated through a coordinated effort between EMS and healthcare providers,” states Dr. Elizabeth Fagan. She continues, “The national goal is a response time of less than 90 minutes from the time the patient arrives at the hospital (door) to the time the blocked artery is open (balloon). Methodist Richardson Medical Center has met that goal 100 percent of the time for nearly three years. For the previous six quarters ‘door to balloon’ time average was only 59 minutes.”

EmCare focuses on helping each hospital partner with efficiency, quality and patient satisfaction. In short, EmCare is making health care work better.™

A Case SampleA 66 year old male experienced and recognized the symptoms associated with a cardiac event and, through a series of controlled coordination between the patient, the EMS and hospital staff, symptom onset through arterial reperfusion (SOAR) was reduced to 43 minutes. This is a significant reduction in response time when compared to the median reported

EmCare focuses on helping

each hospital partner with

efficiency, quality and

patient satisfaction.

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response times in Texas of 171 minutes, or just under three hours. The timeline of events is listed below (some times are approximates):

12:20 pm: A 66 year old male experienced chest pain doing yard

12:28 pm: Patient dials 911

12:33 pm: Richardson Fire Department EMS arrives on scene

12:40 pm: ECG completed and cardiac cath lab was activated from field

12:45 pm: Patient arrives at ER; cardiologist conducted another 12-Lead ECG at the door

12:57 pm: Patient arrives in cardiac cath lab

1:03 pm: Artery opened, blood flow restored to heart

About EmCare®EmCare is the leader in physician servicesTM serving more than 500 hospitals nationwide. Founded nearly 40 years ago, today the company handles more than nine million patient encounters annually. The integrated company consists of four service lines including emergency medicine, hospital medicine, anesthesiology and radiology/teleradiology. The company is focused on:

• Leadership

• Deliveringhighqualityclinicalcare

• Improvingperformancemetrics

• Achievingsuperiorpatientandstaffsatisfaction

• Managingcosts

For more information on how EmCare can help your hospital strengthen its emergency medicine practice, feel free to visit us online at www.EmCare.com. Following the link “Solutions for Hospitals” will offer more information on the services EmCare’s other specialty divisions – Hospital Medicine, Anesthesiology and Radiology / Teleradiology – can provide. You may also contact a business development representative directly at (877) 416-8079.

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