acute myocardial infarction acute myocardial infarction (ami

Download Acute Myocardial Infarction Acute Myocardial Infarction (AMI

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  • 1. Acute Myocardial Infarction (AMI) Initiative Putting All the Pieces in Place
  • 2. About Us Spartanburg Regional Healthcare System 585 beds tertiary referral center Top 100 hospital for advances in computer technology Bariatric Surgery Center of Excellence JCAHO Certified Primary Stroke Center South Carolinas leader in overall heart services. #1 in South Carolina and North Carolina for Heart Surgery 2 Health Grades (10/16/06)
  • 3. About Us Approximately 800 Chest Opened October 2004 Pain Patients per month go through our Chest Pain Clinical Decision Unit South Carolinas 1st Certified Chest Pain Center 2003 Level One Trauma Center: Approximately 100,000 visits annually 3
  • 4. Chest Pain Core Team (Meets Monthly) Physicians: Other Disciplines: Cardiology: Cardiac Cath Lab: N. Srivastava, Medical Director Chest Pain Center M. Petty, Cath Lab Manager R. MacDonald Emergency Center: Emergency Center: W. Finn, Medical Director E.C. C. OHara, E.C. Clinical (previous) Director B. Rody, Medical Director E.C. C. Emmerth, E.C. Clinical (Current) Unit Educator F. Singletary (previous) Heart Center: K. Hanspard (Current) S. Duggar, Interim Executive Director Cardiology/Interim CNO JT Smith, Chest Pain Coordinator B. Hunter, Cardiology Clinical Outcomes Specialist 4
  • 5. Chest Pain Committee (Meets Quarterly) Physicians: Departments Represented: Cardiology: Emergency Medical Services N. Srivastava, Medical (EMS) Director CP Center Regional One R. MacDonald Emergency Center Emergency Center: Cardiology Administration W. Finn, Medical Cardiac Cath Lab Director E.C. (Previous) Critical Care Inpatient Units B. Rody, Medical Director Cardiac Rehab/Wellness E.C. (Current) Hospitalist: Laboratories A. Koser Nuclear Medicine Nuclear Radiologist: Pharmacy/Drug Information B. Joyce Quality Services Vascular Services 5
  • 6. Reducing Mortality and Morbidity Treatments are time dependent and necessitate rapid initiation. The patient must quickly recognize the signs and symptoms of an AMI. The physician must quickly diagnose the AMI and initiate treatment. 6
  • 7. Reperfusion Therapy Treatment Delayed is Treatment Denied Symptom Call to Prehospital ED Cath Lab Recognition Medical System Increasing Loss of Myocytes Delay in Initiation of Reperfusion Therapy 7 (Slide: American College of Cardiology Foundation / American Heart Association) Heart
  • 8. STEMI Time Line (1st Graph Introduced CP Core Team) JANUARY 2005 ST SEGMENT ELEVATION MYOCARDIAL INFARCTION (STEMI) TIME LINE FROM ARRIVAL TO FACILITY TO TIME WIRE CROSSES LESION GOAL: Door-to-PCI = < 120 Minutes 400 350 Chest Pain Center 300 (273M) Clinical Decision Unit Opened October 2004 250 (196M) NUMBER OF MINUTES 200 DIRECT ADMIT 150 (123M) (112M) (105M) TO CATH LAB (83M) 100 (73M) (36M) 50 0 PT # 1 PT # 2 PT # 3 PT # 4 PT # 5 PT # 6 PT # 7 PT # 8 BEGIN TIME TO WIRE ACROSS LESION 10 28 17 21 16 13 21 12 CATH LAB ARRIVAL - BEGIN TIME 14 15 6 13 4 23 17 13 CODE STEMI -CATH LAB 37 16 ECG - CODE STEMI CALLED 32 31 ECG - CATH LAB 81 237 154 EC ARRIVAL - CATH LAB 82 58 D-T-ECG 18 0 0 2 6 4 EMS 0 8
  • 9. Common Factors Identified as Contributing to Failure to Provide Prompt Therapy: Delays in obtaining a 12-Lead ECG Delays in decision-making Delays in consultation of cardiologist Delay or lack of rapidly available serum markers for AMI Society of Chest Pain Centers 9
  • 10. Common Factors Identified as Contributing to Failure to Provide Prompt Therapy Delays related to gender biases Delays related to staff perception of a patients pain as noncardiac Society of Chest Pain Centers 10
  • 11. % Received Thrombolytic Therapy WI 30 Minutes from Arrival to Facility ACUTE MYOCARDIAL INFARCTION (AMI) INITIATIVE % RECEIVED THROMBOLYTIC THERAPY WITHIN 30 MINUTES OF ARRIVAL TO FACILITY (Q3 FY 2006) (HQI - JCAHO - CMS - PREMIER)

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