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Local improvement following national clinical audit workshops Auditing heart attacks Saving lives Dr Andrew Wragg Barts Health Slide 2 Overview National Audits related to Acute Coronary syndromes What do they involve What are our challenges How do we use data: how does it change practice What difference has it made Slide 3 What is a Heart Attack? Slide 4 What is a STEMI and a NON STEMI It is all about ST segment elevation Slide 5 Slide 6 More than just an angioplasty Prompt recognition of symptoms Heart monitoring and resuscitation Prevent further coronary thrombosis Reduce and reverse ischaemia Prevent future MI Education Slide 7 Overview National Audits related to Acute Coronary syndromes What do they involve What are our challenges How do we use data: how does it change practice What difference has it made Slide 8 NICOR MINAP (2000) Myocardial Ischaemia National Audit project All patients presenting with a Acute Coronary Syndromes (ACS) Includes STEMI, Non STEMI and non cardiac chest pain All hospitals who receive acute admissions BCIS (1991) British Cardiac Intervention Society Audit Cover all angioplasty procedures All hospitals undertaking angioplasty Slide 9 MINAP/ BCIS National clinical audits of heart attack management Hospitals, ambulance services and commissioners have a record of their management of heart attack patients Comparative analysis against nationally agreed standards Allows comparative data between centres and regions Clinicians and managers can monitor and improve quality and outcomes of their local services Slide 10 Overview National Audits related to Acute Coronary syndromes What do they involve? What are our challenges? How do we use data: how does it change practice What difference has it made Slide 11 Lots of Data and Manpower > 100 questions in each dataset Detailed medical and technical information Approx 1800 PCI and 1200 MIs at LCH pa BCIS done by medics MINAP done by specialist nurses IT Support needed BUT huge impact Nationally Slide 12 Prescription of secondary prevention medication 5 drugs shown to improve outcome after AMI Aspirin/ Statins/ B Blockers/ ACE I and Clopidogrel Slide 13 Use of secondary prevention post MI continues to improve MINAP report 2010 BLT: over 97% for all therapies Slide 14 30 day mortality post STEMI continues to decline MINAP report 2010 Slide 15 Time is muscle! Slide 16 60180 240 300 360 120 2 8 6 10 4 12 % Mortality Ischaemic time (call to balloon) De Luca, G. et al. Circulation 2004;109:1223-1225 1791 patients with STEMI in USA Relationship between time to treatment and 1-year mortality Double mortality for delay of 3 hours Slide 17 Key Performance targets STEMI (CQC) Call-to-balloon (CTB) audit standard 150 mins Door-to-balloon (DTB) audit standard 90 mins Length of stay Mortality Slide 18 Slide 19 Admitted from the community Direct admission to PCI centre Transfer to PCI centre Admission to Non-PCI centre PCI for Acute Sx Four admission scenarios device D1 D2 V CTB DTB Slide 20 Performance time targets Door to balloon: 80% less than 90 mins Call to balloon: 75% less than 150 mins Direct transfer rate: >80% Slide 21 How did BLT do! 2009 data Door to balloon: 80% < 90 mins Call to balloon: 75% 80% Door to balloon: 85% < 90 mins Call to balloon: 56% < 150 mins Direct transfer rate: 50% We had to improve! Slide 22 Overview National Audits related to Acute Coronary syndromes What do they involve What are our challenges How do we use data: how does it change practice What difference has it made Slide 23 HAC Daily Audit Weekly Report Straight to Lab Internal DTB