reperfusion therapies 2007
TRANSCRIPT
Pennsylvania CHAPTERIn cooperation with Highmark and Independence Blue Cross(Blue Plans headquartered in Pittsburgh and Philadelphia)
The Mission of the American College of Cardiology……
- “to foster optimal cardiovascular care and disease prevention through
professional education, promotion of research, leadership in the development of
standards and guidelines and the formulation of health care policy.”
Reperfusion Therapies 2007
Strategies for Developing
Integrated D2B Programs
For STEMI
Pennsylvania CHAPTERIn cooperation with Highmark and Independence Blue Cross(Blue Plans headquartered in Pittsburgh and Philadelphia)
Pennsylvania CHAPTER
In cooperation with Highmark and Independence Blue Cross(Blue Plans headquartered in Pittsburgh and Philadelphia)
Donald R. Fischer, M.D., MBASenior Vice PresidentChief Medical Officer
Highmark
Michael A. Madden, M.D.Medical Director
Quality and Medical Performance Management
Highmark
Highmark Lori Armel
Karen BalsamoFlo Campbell
Deborah J. DonovanLynette EndersDouglas HochPaul Hoffman
Trina Thompson
Carey Vinson, M.D.Medical Director
Highmark
THANK
YOU
Victor Caraballo, M.D.Senior Medical Director
Quality ManagementIndependence Blue Cross
Kathleen T. DonohueIndependence Blue Cross
Steven J. Brown, M.D.Medical Director
Professional Networks
Phil GehmanProvider Improvement
Project LeaderIndependence Blue Cross
Teamwork
Pennsylvania CHAPTER
In cooperation with Highmark and Independence Blue Cross(Blue Plans headquartered in Pittsburgh and Philadelphia)
Pennsylvania Chapter –American College of Cardiology
Maria EliasAssociation Executive
American College of CardiologyJason Byrd
Jayne JordanAmy Stern
THANK
YOU
Tracy Allgier-BakerDirector of Continuing Education
Penn State College of Medicine
Bonnie Bixler, M.Ed.Director of Special Projects
Penn State Continuing EducationCollege of Medicine
Lori L. FitterlingJulie Graham
Penn State Continuing Education
Teamwork
Reperfusion Therapies 2007
P4P Programs
Pennsylvania CHAPTERIn cooperation with Highmark and Independence Blue Cross(Blue Plans headquartered in Pittsburgh and Philadelphia)
PROFESSIONALS for
PERFUSION
Reperfusion Therapies 2007
Welcome and Introduction
Michael A. Madden, M.D. : Highmark
Richard L. Snyder, M.D. : IBC
Daniel Edmundowicz, M.D. : Pa-ACC
Pennsylvania CHAPTERIn cooperation with Highmark and Independence Blue Cross(Blue Plans headquartered in Pittsburgh and Philadelphia)
Reperfusion Therapies 2007
The Vision:
Improving D2B Time for STEMI
Pennsylvania CHAPTERIn cooperation with Highmark and Independence Blue Cross(Blue Plans headquartered in Pittsburgh and Philadelphia)
Pennsylvania CHAPTER
In cooperation with Highmark and Independence Blue Cross(Blue Plans headquartered in Pittsburgh and Philadelphia)
"The secret of success in life is for a (wo)man to be ready for (her) his opportunity when it comes."
-Benjamin Disraeli
"Education brings about opportunity, and in turn inspiration." -Bill Frist
"A pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty."
-Winston Churchill
ACC-D2B
Pennsylvania CHAPTER
In cooperation with Highmark and Independence Blue Cross(Blue Plans headquartered in Pittsburgh and Philadelphia)
Primary PCI should be performed as quickly as possible, with a goal of a medical contact-to-balloon or door-to-balloon time within 90 minutes.
ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Interventions
In July 2005 the Penn State Heart & Vascular Instituteas part of a quality improvement initiative reviewed
D2B for STEMI patients:
Door-to-ECG : 36 min (mean); range : 10-132 minECG-to-PCI : 109 min (mean); range : 71-363 minDoor-to-Balloon time : 145 min (mean)
ACC-D2B
Pennsylvania CHAPTER
In cooperation with Highmark and Independence Blue Cross(Blue Plans headquartered in Pittsburgh and Philadelphia)
Door-to-Balloon time : 145 min (mean)
"Kubler-Ross Stages in Facing Reality of the Quality Chasm"
1. The data are wrong2. The data are right, but it’s not a problem3. The data are right, but it’s not my problem4. I accept the burden of quality improvement
Donald Berwick, Institute of Medicine Crossing the Quality Chasm SummitWashington D.C., January 2004
ED Nurse initiates acute care
Heart Alert Intake Worksheet
Idealized Workflow
Presenting symptoms suggestive of ACS
ECG performed within 10 minutes
ECG reviewed by ED attending
CARDIOLOGIST PAGED
STEMI “confirmed”STEMI “confirmed”
Penn State Heart & Vascular Institute
Pennsylvania CHAPTER
In cooperation with Highmark and Independence Blue Cross(Blue Plans headquartered in Pittsburgh and Philadelphia)
Y.O.U.R. Medical Center
HOSPITAL ADMINISTRATIONHVI /EM LEADERSHIP
ADMISSSIONSCOMMUNICATIONS
NURSINGANCILLARY SERVICES
PARAMEDICSLIFE LION
PHYSICIANS MD NETWORK
FELLOWSINTERVENTIONAL CRNPCVOU SUPPORT STAFF
CARDIAC CATH LAB STAFFSIM LAB
I.T. SERVICES
Penn State Heart & Vascular Institute
Penn State Heart & Vascular Institute
ED Physician Empowerment
Heart Alert Paging System Activated
ED Attending ActivatesHeart Alert System
Attending to AttendingCase discussion
Classic STEMIPossible STEMI
Cardiology Attendingpaged
Heart Alert Paging System
1. Interventional Cardiologist [on-call]2. Cath Lab “Charge” [organize room]3. Cardiology Fellow [on-call]4. Cath Lab call-team5. Interventional Nurse Practitioner6. Hospital Admissions7. Research Nurse(s)8. ED Charge Nurse9. Radiology Technologist
“RESPONDERS”
01/01/2007 06:30 HEART ALERTED- ROOM 19
RESPOND STAT
Penn State Heart & Vascular Institute
1. Is family present Y / N 2. Is a translator necessary? : No / Yes :_________________(language)3. Vitals: BP_______; HR_______; RR_______4. Jugular venous distention : No / Yes: _________ 5. Pulmonary : rales ____; wheezes_____6. Cardiac auscultation: murmurs ______; gallops ______7. Pulses: femoral: R_____; L_____; Radial: R____; L___8. Symptoms: Chest Pain _______; time of onset______; Shortness of breath _______;9. Allergies- No / YES: ______________________________; Iodine______; Shellfish_____10. Prior : Cardiac cath______; Angioplasty______; CABG_____;11. Height_________________12. Weight ________________13. Dentures Yes / No14. Time of Last Meal ____________________15. Hearing Aid Yes / No16. Contacts Yes / No 17. IV Meds (circle if administered): Dopamine, Dobutamine,, Nitroglycerin, Heparin, Aspirin
ED MD______________ED NURSE___________
Date ______Time______
Cath Lab: ext 6416Patient ID Sticker
Penn State Heart & Vascular Institute
Heart Alert Intake Worksheet
Fax: 717-531-1074
Triage to ECG
ECG toHeart AlertActivation
PCI
Penn State Heart & Vascular Institute
Heart Alert Program- GOALS
Heart AlertActivation toCath LabTeam arrival
Patient’sArrival to Cath Lab
10 min 10 min 30 min 5 min 35 min
Door-to-BalloonTime:90 min
Steven Ettinger, Charles Chambers, Ian Gilchrist, Mark Kozak, Craig Lauder & Lawrence Sinoway
March 25, 2007
Quality Improvement: Reducing Door-to-Balloon Time (D2B) in Patients With ST-segment Elevation Myocardial Infarction:
Heart Alert Program
PENN STATE HEART & VASCULAR
INSTITUTE
Triage to ECG
ECG toHeart AlertActivation
PCI
Penn State Heart & Vascular Institute
Heart Alert Program
Heart AlertActivation toCath LabTeam arrival
Patient’sArrival to Cath Lab
9.0 min 3.9 min 19.6 min 12.8 min 28.5 min
2007Door-to-Balloon
Time:73.8 min (mean)
(86% within 90 min)
Door-to-BalloonTime:
85.7 min (mean)(140 patients enrolled)
Pennsylvania CHAPTER
In cooperation with Highmark and Independence Blue Cross(Blue Plans headquartered in Pittsburgh and Philadelphia)
March, 2007- Pa-ACC, Highmark and IBC working group organized to plan Reperfusion Therapies 2007-
The Vision:1. Review current pathways and protocols2. Recognize best-practice models3. Recognize D2B times < 90 min are achievable4. Recognize together we can and we will make a difference
Medical Directors' Institute : October 18- 20, 2006 Leesburg, Virginia
Created in 2002 by the ACC with the intention of developing a collaborative approach to issues such as paying for quality, utilization of imaging technology, health information systems and value in healthcare.
Pennsylvania CHAPTER
In cooperation with Highmark and Independence Blue Cross(Blue Plans headquartered in Pittsburgh and Philadelphia)
State Program
We can do better………….
Optimize STEMI Care
Pennsylvania CHAPTER
In cooperation with Highmark and Independence Blue Cross(Blue Plans headquartered in Pittsburgh and Philadelphia)
Regionalize STEMI Care
EDUCATION
Pa-ACC D2B
Pennsylvania CHAPTER
In cooperation with Highmark and Independence Blue Cross(Blue Plans headquartered in Pittsburgh and Philadelphia)
Now you know what it is like to develop a “Door-to-Balloon” program
Step back and run into thiswall head first……….
www.d2balliance.com
www.d2balliance.com
www.d2balliance.com
www.d2balliance.com
www.d2balliance.com
www.d2balliance.com
www.d2balliance.com
Harlan M. Krumholz, M.D., F.A.C.C.Yale University School of Medicine
ACC- GAPChair, Door-to-Balloon Work Group
Pennsylvania CHAPTER
In cooperation with Highmark and Independence Blue Cross(Blue Plans headquartered in Pittsburgh and Philadelphia)
D2B ProgramEmergency Medical Services
Expert Panel:• Donald Durbeck
• Vincent N. Mosesso Jr.
• Judd E. Hollander
• David Neubert
• Andrew Miller
D2B ProgramEmergency Medical Services
9:05- 9:15 am: Can STEMI Patients Transferred for Primary Angioplasty Receive Treatment Within 90- minutes in a Rural Setting? – Geisinger Medical Center
9:20- 9:30 am: Improving STEMI Care in Eastern Pennsylvania: The Lehigh Valley Hospital and Health Network MI-Alert Program – Lehigh Valley Hospital
9:35- 9:45 am: Reducing D2B Time in STEMI by Utilizing EMS Cath Lab Activation From the Field & Intradepartmental Emergency Physician Activation: An 11-year 24/7/365 Experience – Mercy Hospital of Pittsburgh
9:50- 10:00 am: Improving D2B Time in STEMI– Presbyterian Shadyside
10:05- 10:15 am: Delay to Electrocardiogram in STEMI Patients Does Not Preclude Meeting 90-minute D2B Time – Albert Einstein Medical Center
November 21-23, 2008 Kiss this Date Goodbye on
your Calendar!Why?
Because you do not want to miss this meeting!
2008 Annual Pa-ACC Chapter Meeting
November 21-23, 2008
The Hotel Hershey
Sure to be a SWEET Event!
John J. Kelly, D.O., F.A.C.E.P. Albert Einstein Medical Center
Associate ChairmanDepartment of Emergency Medicine
D2B Strategies and the Role of the Emergency Department
Pennsylvania CHAPTER
In cooperation with Highmark and Independence Blue Cross(Blue Plans headquartered in Pittsburgh and Philadelphia)
D2B ProgramEmergency Medicine
Expert Panel:• John Doherty
• Craig Lauder
• Paul Casale
• Andrew Waxler
• Michael Rossi
• Howard Herrmann
D2B ProgramEmergency Medicine
11:15 - 11:25 am: – Cardiac Reperfusion Team Protocol Decreases D2B Time at Hamot Medical Center- Hamot Medical Center
11:30 - 11:40 am: D2B Time: Every Minute Counts – Conemaugh Memorial Medical Center
11:45- 11:55 am: Emergency Physician Activation of the Catheterization Lab Reduces D2B Times with Few False Activations – Hahnemann University
Douglas Kupas, M.D.Commonwealth EMS Medical Director
Bureau of EMSPennsylvania Department of Health
EMS and D2B Strategies: The Pennsylvania Perspective
Pennsylvania CHAPTER
In cooperation with Highmark and Independence Blue Cross(Blue Plans headquartered in Pittsburgh and Philadelphia)
Howard C. Herrmann, M.D., F.A.C.C.Director, Interventional Cardiology andCardiac Catheterization Laboratories
University of Pennsylvania
Is There a Role For Facilitated PCI in 2007 ?
Pennsylvania CHAPTER
In cooperation with Highmark and Independence Blue Cross(Blue Plans headquartered in Pittsburgh and Philadelphia)
D2B ProgramInterventional Cardiology
Expert Panel:• Ian Gilchrist
• A.J. Conrad Smith
• Nelson Wolf
• Charles Chambers
• James Blankenship
D2B ProgramInterventional Cardiology
1:40 - 1:50 pm: – Processes to Decrease D2B Times for STEMI Patients in a Community Hospital- Saint Vincent Health Center
1:55 - 2:05 pm: Overall Catheterization Laboratory Normal Angiography Rate Does Not Increase with ER Activation of Primary Coronary Interventions (PCI) for STEMI – Chester County Hospital
2:10- 2:20 pm: Are Women Undergoing Primary PCI at Increased Risk for Death? Insights from the Lehigh Valley Hospital and Health Network MI-ALERT Program – Lehigh Valley Hospital
2:25- 2:35 pm: Interdisciplinary Collaboration to Reduce D2B Time – Abington Memorial Hospital
D2B ProgramInterventional Cardiology
2:40 - 2:50 pm: – D2B Time: The Pinnacle Health Experience- Pinnacle Health
2:55 - 3:05 pm: Overcoming the Hurdles: Improving D2B in the LVHHN MI-ALERT Program – Lehigh Valley Hospital
3:10- 3:20 pm: Time to Treatment During Primary PCI is Related to Transport Distance and Speed of Interventionalist – Geisinger Medical Center
Reperfusion Therapies 2007
Strategies for Developing
Integrated D2B Programs
For STEMI
Pennsylvania CHAPTERIn cooperation with Highmark and Independence Blue Cross(Blue Plans headquartered in Pittsburgh and Philadelphia)
CONCLUDING REMARKS
Reperfusion Therapies 2007
If you don’t know the data, you can’t get better.
Reperfusion strategies are essential
Quality is a Culture
Educate – Standardize - Regionalize
State Organizations should collaborate
Pennsylvania CHAPTERIn cooperation with Highmark and Independence Blue Cross(Blue Plans headquartered in Pittsburgh and Philadelphia)
Mission: LifelineMarch 2006- AHA multidisciplinary conference
•STEMI patient care
•Implementation Plan:
–EMS system assessment and improvement
–Establishing local initiatives
–Evaluating existing models
–Explore the possibility of developing a National STEMI Center Certification Program/Criteria
Pennsylvania CHAPTERIn cooperation with Highmark and Independence Blue Cross(Blue Plans headquartered in Pittsburgh and Philadelphia)
AHAStroke- Recommendations for the establishment of stroke systems of care
Brain Defense- A Stroke Prevention and Treatment Strategy for Pennsylvania –
•Presented to the General Assembly of the Commonwealth of PA – Joint State Government Commission – November 2002
Pennsylvania CHAPTERIn cooperation with Highmark and Independence Blue Cross(Blue Plans headquartered in Pittsburgh and Philadelphia)
Statewide Systems ChangeDevelop Taskforce/Committee under Department of Health CVD ConsortiumDevelop plan and progress markersAssess resources / capabilitiesFocus on long term outcomes
Pennsylvania CHAPTERIn cooperation with Highmark and Independence Blue Cross(Blue Plans headquartered in Pittsburgh and Philadelphia)
Improving OutcomesThrough a Culture of a
Collaborative Environment
Pennsylvania CHAPTERIn cooperation with Highmark and Independence Blue Cross(Blue Plans headquartered in Pittsburgh and Philadelphia)
&
THANK YOU
Pennsylvania CHAPTERIn cooperation with Highmark and Independence Blue Cross(Blue Plans headquartered in Pittsburgh and Philadelphia)