Acute Myocardial Infarction Acute Myocardial Infarction (AMI) Initiative(AMI) Initiative

Putting All the Pieces in PlacePutting All the Pieces in Place

22

About UsAbout Us

Spartanburg Regional Healthcare System

““South CarolinaSouth Carolina’’s leader in overall heart services.s leader in overall heart services.

#1 in South Carolina and North Carolina for #1 in South Carolina and North Carolina for Heart SurgeryHeart Surgery””

Health Grades (10/16/06)Health Grades (10/16/06)

585 beds 585 beds –– tertiary referral centertertiary referral center

•• Top 100 hospital for advances in Top 100 hospital for advances in computer technologycomputer technology

•• Bariatric Surgery Center of Bariatric Surgery Center of ExcellenceExcellence

•• JCAHO Certified Primary JCAHO Certified Primary Stroke CenterStroke Center

33

About UsAbout Us

Level One Trauma Center: Level One Trauma Center: Approximately 100,000 visits annuallyApproximately 100,000 visits annually

South CarolinaSouth Carolina’’s 1s 1stst

Certified Chest Pain Center Certified Chest Pain Center 20032003

Approximately 800 Chest Approximately 800 Chest Pain Patients per month Pain Patients per month go go through our through our Chest Pain Chest Pain Clinical Decision UnitClinical Decision Unit

Opened October 2004Opened October 2004

44

Chest Pain Core TeamChest Pain Core Team(Meets Monthly)(Meets Monthly)

PhysiciansPhysicians::Cardiology:Cardiology:

N. Srivastava, N. Srivastava, Medical Medical Director Chest Pain CenterDirector Chest Pain Center

R. MacDonaldR. MacDonaldEmergency Center:Emergency Center:

W. Finn, W. Finn, Medical Director E.C. Medical Director E.C. (previous)(previous)

B. RodyB. Rody, Medical Director E.C. , Medical Director E.C. (Current)(Current)

F. Singletary F. Singletary (previous)(previous)

K. Hanspard K. Hanspard (Current)(Current)

Other DisciplinesOther Disciplines::Cardiac Cath Lab:Cardiac Cath Lab:

M. Petty, M. Petty, Cath Lab Cath Lab ManagerManager

Emergency Center:Emergency Center:C. OC. O’’Hara, Hara, E.C. Clinical E.C. Clinical DirectorDirector

C. Emmerth, C. Emmerth, E.C. Clinical E.C. Clinical Unit EducatorUnit Educator

Heart Center:Heart Center:S. DuggarS. Duggar, , Interim Executive Interim Executive Director Cardiology/Interim CNODirector Cardiology/Interim CNO

JT SmithJT Smith, Chest Pain , Chest Pain CoordinatorCoordinator

B. HunterB. Hunter, Cardiology Clinical , Cardiology Clinical Outcomes SpecialistOutcomes Specialist

55

Chest Pain CommitteeChest Pain Committee(Meets Quarterly)(Meets Quarterly)

PhysiciansPhysicians::Cardiology:Cardiology:

N. Srivastava, N. Srivastava, Medical Medical Director CP CenterDirector CP Center

R. MacDonaldR. MacDonaldEmergency Center:Emergency Center:

W. Finn, W. Finn, Medical Medical Director E.C. (Previous)Director E.C. (Previous)

B. RodyB. Rody, Medical Director , Medical Director E.C. (Current)E.C. (Current)

Hospitalist:Hospitalist:A. KoserA. Koser

Nuclear Radiologist:Nuclear Radiologist:B. JoyceB. Joyce

Departments RepresentedDepartments Represented::Emergency Medical Services Emergency Medical Services (EMS)(EMS)Regional OneRegional OneEmergency Center Emergency Center Cardiology AdministrationCardiology AdministrationCardiac Cath LabCardiac Cath LabCritical Care Inpatient UnitsCritical Care Inpatient UnitsCardiac Rehab/WellnessCardiac Rehab/WellnessLaboratoriesLaboratoriesNuclear MedicineNuclear MedicinePharmacy/Drug InformationPharmacy/Drug InformationQuality ServicesQuality ServicesVascular ServicesVascular Services

66

Reducing Mortality and MorbidityReducing Mortality and Morbidity

Treatments are time dependent Treatments are time dependent and necessitate rapid initiation.and necessitate rapid initiation.The patient must quickly The patient must quickly recognize the signs and recognize the signs and symptoms of an AMI.symptoms of an AMI.The physician must quickly The physician must quickly diagnose the AMI and initiate diagnose the AMI and initiate treatment.treatment.

77

Symptom Recognition

Call to Medical System

ED Cath LabPrehospital

Delay in Initiation of Reperfusion Therapy

Increasing Loss of Myocytes

Treatment Delayed is Treatment DeniedTreatment Delayed is Treatment Denied

Reperfusion TherapyReperfusion Therapy

(Slide: American College of Cardiology Foundation / American Hea(Slide: American College of Cardiology Foundation / American Heart Association)rt Association)

88

STEMI Time LineSTEMI Time Line(1(1stst Graph Introduced CP Core Team)Graph Introduced CP Core Team)

0

50

100

150

200

250

300

350

400

NUMBER OF MINUTES

JANUARY 2005ST SEGMENT ELEVATION MYOCARDIAL INFARCTION (STEMI)

TIME LINE FROM ARRIVAL TO FACILITY TO TIME WIRE CROSSES LESION

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 0

PT # 1 PT # 2 PT # 3 PT # 4 PT # 5 PT # 6 PT # 7 PT # 8

(123M)(112M) (105M)

(273M)

(73M)

(36M)

DIRECT ADMIT TO CATH LAB

(196M)

(83M)

EMS

GOAL: Door-to-PCI = < 120 Minutes

Chest Pain Center Clinical Decision Unit Opened October 2004

99

Common Factors Identified as Contributing Common Factors Identified as Contributing to Failure to Provide Prompt Therapy:to Failure to Provide Prompt Therapy:

Delays in obtaining a 12Delays in obtaining a 12--Lead ECGLead ECG

Delays in decisionDelays in decision--makingmaking

Delays in consultation of cardiologistDelays in consultation of cardiologist

Delay or lack of rapidly available Delay or lack of rapidly available serum markers for AMIserum markers for AMI

Society of Chest Pain CentersSociety of Chest Pain Centers

1010

Common Factors Identified as Contributing Common Factors Identified as Contributing to Failure to Provide Prompt Therapyto Failure to Provide Prompt Therapy

Delays related to gender biasesDelays related to gender biases

Delays related to staff perception of a Delays related to staff perception of a patientpatient’’s pain as noncardiacs pain as noncardiac

Society of Chest Pain CentersSociety of Chest Pain Centers

1111

% Received Thrombolytic Therapy % Received Thrombolytic Therapy WI WI 30 Minutes from Arrival to Facility30 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)

0

14.29

66.667

00

29.41 28.5728.57

0

20

40

60

80

100

Q1 FY2003

Q2 FY2003

Q3 FY2003

Q4 FY2003

Q1 FY2004

Q2 FY2004

Q3 FY2004

Q4 FY2004

Q1 FY2005

Q2 FY2005

Q3 FY2005

FY 2005 Q1 FY2006

Q2 FY2006

Q3 FY2006

TIME FRAME

% C

OM

PLIA

NC

E

SRHS HQI 1st (Top) Decile HQI Top 2nd Decile HQI 50% HQI: 8th Decile MIDAS* JCAHO*

HQI: 1st (Top) Decile

HQI: Top 2nd Decile

HQI: Top 50%

HQI: 8th Decile

MIDAS Comparative JCAHO

HQI

66.67%

57.14%

0%(0/3)

(0/2)

(0/5)

No Thrombolytic Given

Q1 FY 2006Q3 FY 2006

25.0%

MEAN TIME Q2 FY 2006 = 24.3 minutes1 case outlier by 3 minutes

(1/7)

(2/3)

Thrombolytic Therapy Rarely Given Thrombolytic Therapy Rarely Given ……Alternative when Cath Lab UnavailableAlternative when Cath Lab Unavailable

1212

% Received Primary PCI WI 120 % Received Primary PCI WI 120 Minutes from Arrival to FacilityMinutes from Arrival to Facility

ACUTE MYOCARDIAL INFARCTION (AMI) INITIATIVE% RECEIVED PRIMARY PCI WITHIN 120 MINUTES FROM ARRIVAL TO FACILITY

(Q3 FY 2006)(HQI - JCAHO - CMS - PREMIER)

92.593

42.8653.33 53

66.67

96.296

70.83

31.58

22.22

31.82

91.176

0

20

40

60

80

100

Q1 FY2003

Q2 FY2003

Q3 FY2003

Q4 FY2003

Q1 FY2004

Q2 FY2004

Q3 FY2004

Q4 FY2004

Q1 FY2005

Q2 FY2005

Q3 FY2005

FY 2005 Q1 FY2006

Q2 FY2006

Q3 FY2006

TIME FRAME

% C

OM

PLIA

NC

E

SRHS HQI 1st (Top) Decile HQI Top 2nd Decile HQI 50% HQI: 8th Decile MIDAS* JCAHO*

HQI 1st (Top) Decile

HQI Top 2nd Decile

HQI Top 50%

HQI 8th Decile

HQI

88.0%

81.42%

67.19%

42.22%SRHS

MIDAS Comparative

JCAHO

(26/27)

(25/27)

(58/87)

July 2006 no longer reporting DoorJuly 2006 no longer reporting Door--toto--PPCI WI 120 MinutesPPCI WI 120 Minutes

1313

% Received Primary PCI WI 90 % Received Primary PCI WI 90 Minutes from Arrival to FacilityMinutes from Arrival to Facility

ACUTE MYOCARDIAL INFARCTION (AMI) INITIATIVE% RECEIVED PRIMARY PCI WITHIN 90 MINUTES FROM ARRIVAL TO FACILITY

(Q3 FY 2006)(HQI - JCAHO - CMS - PREMIER)

0

48.148

73.529

10.53

55.556

33.333

29.17

35.2933.33

0

10

20

30

40

50

60

70

80

Q3 FY 2004 Q4 FY 2004 Q1 FY 2005 Q2 FY 2005 Q3 FY 2005 Q4 FY 2005 Q1 FY 2006 Q2 FY 2006 Q3 FY 2006

TIME FRAME

% C

OM

PLIA

NC

E

SRHS HQI 1st (Top) Decile HQI Top 2nd Decile HQI 50% HQI: 8th Decile MIDAS* JCAHO*

MIDAS Comparative

SRHS

(7/24)

(6/17)(5/15)

(2/19)(0/18)

Chest Pain Center Clinical Decision Unit Opened Oct 2004 "CODE STEMI" implemented Nov 2004

Mean Times: Q1 FY 2006 (84.3) Q2 FY 2006 (79.3) Q3 FY 2006 (88.3)

(10/30)

(15/27)

(13/27)

1414

Cardiac Cath LabCardiac Cath Lab

1515

STEMI TimelineSTEMI Timeline

0

20

40

60

80

100

120

140

Num

ber o

f Min

utes

APRIL-MAY 2006ST Segment Elevation Myocardial Infarction (STEMI)

Time Line From Arrival to Facility to 1st Balloon Inflation

D-T-ECG Direct Admit - CATH LAB ECG - CATH LABECG - CODE STEMI CALLED CODE STEMI -CATH LAB CATH LAB ARRIVAL - BEGIN TIMECATH LAB ARRIVAL - READY TIME READY TIME - BEGIN TIME "BEGIN TIME" TO "1st BALLOON INFLATION"

"BEGIN TIME" TO "1st BALLOON INFLATION" 28 30 33 20 28 23 18 34 31 25 20 19 17 19 17 17 21 9

READY TIME - BEGIN TIME 1 4 7 1 5 3 2 5 6 3 2 9 7 2 7 2 18 3

CATH LAB ARRIVAL - READY TIME 10 4 13 11 9 10 10 8 9 1 4 4 6 6 4 5 4 8

CATH LAB ARRIVAL - BEGIN TIME

CODE STEMI -CATH LAB 21 12 41 25 36 47 50 22 54 29 33 57 43 52 20

ECG - CODE STEMI CALLED 0 26 30 8 8 12 3 0 0 3 15 0 13 0

ECG - CATH LAB 46 76 51 2

Direct Admit - CATH LAB

D-T-ECG 3 0 2 21 4 9 3 9 14 0 1 3 6 31 0 21 0 0

APR # 1

APR # 2

APR # 3

APR # 4

APR # 5

APR # 6

APR # 7

APR # 8

MAY # 1

MAY # 2

MAY # 3

MAY # 4

MAY # 5

MAY # 6

MAY # 7

MAY # 8

MAY # 9

MAY # 10

Cath Lab Defintions: Ready Time = Pt prepped/draped Begin Time = MD present/local given

Goal = < 90 Minutes

1616

GOAL: Decrease DoorGOAL: Decrease Door--toto--PPCI PPCI Times < 90 MinutesTimes < 90 Minutes

GOALS: GOALS: ““CODE STEMICODE STEMI”” Timeline:Timeline:(Recommended by CP Core Team)(Recommended by CP Core Team)

DoorDoor--toto--ECGECG……..5 minutes..5 minutesECGECG--toto--Call of Call of ““CODE STEMICODE STEMI”…”…..5 minutes..5 minutes““CODE STEMICODE STEMI”” ––toto--Arrival to Cath LabArrival to Cath Lab…….. 30 minutes.. 30 minutesCath Lab ArrivalCath Lab Arrival--toto--Begin TimeBegin Time……..15 minutes..15 minutesBegin TimeBegin Time--toto--11stst Balloon InflationBalloon Inflation……..15 minutes..15 minutes

TOTAL: 70 MinutesTOTAL: 70 Minutes

Goals Approved: Cardiology Physician Advisory CouncilGoals Approved: Cardiology Physician Advisory Council

1717

GOAL: Decrease DoorGOAL: Decrease Door--toto--PPCI PPCI Times < 90 MinutesTimes < 90 Minutes

Coming AttractionComing Attraction::Transmission of 12Transmission of 12--Lead Lead

ECG from the field ECG from the field (EMS) or from Regional (EMS) or from Regional One via an interface One via an interface from Life Pak 12 to a from Life Pak 12 to a telephone/radio telephone/radio receiver to a receiver to a ……..

1818

GOAL: Decrease DoorGOAL: Decrease Door--toto--Primary Primary PCI Times to < 90 MinutesPCI Times to < 90 Minutes

Receiving station in CP Center Receiving station in CP Center CDU, reviewed by E.C. Physician CDU, reviewed by E.C. Physician and then beamed to and then beamed to ……..

Cardiologist on callCardiologist on call’’s s PDA for rapid decision PDA for rapid decision to Cardiac Cath Labto Cardiac Cath Lab

Other AMI IndicatorsOther AMI Indicators

2020

Aspirin Received WI 24HAspirin Received WI 24HACUTE MYOCARDIAL INFARCTION (AMI) INITIATIVE

ASPIRIN RECEIVED WITHIN 24 HOURS OF ARRIVAL TO FACILITY(Q3 FY 2006)

(JCAHO - HQA - CMS/ Premier HQI - IHI)

90.28

93.01

95.15

96.7

100

94.93

97.248

93.333

96.078 96.0

88.39

95.08

98.0

93.75

91.8

80

85

90

95

100

Q1 FY2003

Q2 FY2003

Q3 FY2003

Q4 FY2003

Q1 FY2004

Q2 FY2004

Q3 FY2004

Q4 FY2004

Q1 FY2005

Q2 FY2005

Q3 FY2005

FY 2005 Q1 FY2006

Q2 FY2006

Q3 FY2006

TIME FRAME

% C

OM

PLIA

NC

E

SRHS HQI Top 10% HQI Top 20% HQI: 5TH (MEDIAN)HQI:YEAR 1 BASELINE: 8th MIDAS COMPARATIVE JCAHO EXPECTED*

HQI 1st (Top) Decile

HQI Top 2nd Decile

HQI Top 50%

HQI 8th Decile

HQISRHS GOAL: 100% Compliance

SRHS

JCAHO

MIDAS Comparative

99.65%

98.11%

90.76%

95.83%

(98/105)

(106/109)

(393/314)

(99/99)

Q3 FY 2006 Opportunities Identified:Q3 FY 2006 Opportunities Identified:NONE, Met StandardNONE, Met Standard

2121

Beta Blockers WI 24HBeta Blockers WI 24H

ACUTE MYOCARDIAL INFARCTION (AMI) INITIATIVEBETA BLOCKER RECEIVED WITHIN 24 HOURS FROM ARRIVAL TO FACILITY

(Q3 FY 2006)(JCAHO HQA - CMS/Premier HQI - IHI)

100

98.649

97.701

95.297.85

89.69

94.56595.492.3192.4292.5992.2291.21

92.9296.05

50

60

70

80

90

100

Q1 FY2003

Q2 FY2003

Q3 FY2003

Q4 FY2003

Q1 FY2004

Q2 FY2004

Q3 FY2004

Q4 FY2004

Q1 FY2005

Q2 FY2005

Q3 FY2005

FY 2005 Q1 FY2006

Q2 FY2006

Q3 FY2006

TIME FRAME

% C

OM

PLIA

NC

E

SRHS HQI Top 10% HQI Top 20% HQI: 5TH (MEDIAN)HQI:YEAR 1 BASELINE: 8th MIDAS COMPARATIVE JCAHO EXPECTED*

HQI 1st (Top) Decile

HQI Top 2nd Decile

SRHSHQI Top 50%

JCAHOMIDAS Comparative HQI 8th Decile

HQI99.42%

97.67%

93.89%

81.82%

(85/87)

(337/354)

(84/84)

(73/74)

Q3 FY 2006 Opportunities IdentifiedQ3 FY 2006 Opportunities Identified: (1 case): (1 case)Process issue where the Process issue where the ““NOWNOW”” dose was not transcribed/documented as being givendose was not transcribed/documented as being given

2222

Aspirin Prescribed @ DischargeAspirin Prescribed @ Discharge

ACUTE MYOCARDIAL INFARCTION (AMI) INITIATIVEASPIRIN PRESCRIBED AT DISCHARGE

(Q3 FY 2006)(JCAHO - HQA - CMS/Premier HQI - IHI)

94.16

96.73

95.2496.45

97.26

99.346

97.72797.6 98.43

99.324

98.551

94.0894.12

98.73

92.05

80

85

90

95

100

Q1 FY2003

Q2 FY2003

Q3 FY2003

Q4 FY2003

Q1 FY2004

Q2 FY2004

Q3 FY2004

Q4 FY2004

Q1 FY2005

Q2 FY2005

Q3 FY2005

FY 2005 Q1 FY2006

Q2 FY2006

Q3 FY2006

TIME FRAME

% C

OM

PLIA

NC

E

SRHS HQI Top 10% HQI Top 20% HQI: 5TH (MEDIAN)HQI:YEAR 1 BASELINE: 8th MIDAS COMPARATIVE JCAHO EXPECTED*

HQI 1st (Top) DecileHQI Top 2nd Decile

HQI Top 50%

HQI 8th Decile

SRHSMIDAS Comparative

JCAHO

HQI

99.6%

99.08%

96.21%

86.84%

(147/148)

(533/548)

(152/153)

(129/132)

Q3 FY 2006 Opportunities Identified: (3 cases)Q3 FY 2006 Opportunities Identified: (3 cases)♥♥ 1 case 1 case

♥♥ 2 cases 2 cases

-- Aspirin received day of discharge; however, not listed in PhysiAspirin received day of discharge; however, not listed in Physician Discharge cian Discharge Summary nor the Universal Medication FormSummary nor the Universal Medication Form

–– Aspirin only ordered as Aspirin only ordered as ““NOWNOW”” dose on admission; daily dose never ordereddose on admission; daily dose never ordered

2323

Beta Blocker Prescribed @ DischargeBeta Blocker Prescribed @ Discharge

ACUTE MYOCARDIAL INFARCTION (AMI) INITIATIVEBETA BLOCKER PRESCRIBED AT DISCHARGE

(Q3 FY 2006)(JCAHO- HQA - CMS/ Premier HQI- IHI)

95.98 95.48

98.57198.56 99.398

95.7193.2994.3

98.098.7897.89

99.2498.63

93.79

89.62

50

60

70

80

90

100

Q1 FY2003

Q2 FY2003

Q3 FY2003

Q4 FY2003

Q1 FY2004

Q2 FY2004

Q3 FY2004

Q4 FY2004

Q1 FY2005

Q2 FY2005

Q3 FY2005

FY 2005 Q1 FY2006

Q2 FY2006

Q3 FY2006

TIME FRAME

% C

OM

PLIA

NC

E

SRHS HQI Top 10% HQI Top 20% HQI: 5TH (MEDIAN)HQI:YEAR 1 BASELINE: 8th MIDAS COMPARATIVE JCAHO EXPECTED*

HQI 1st (Top) Decile

HQI Top 2nd Decile

HQI Top 50%

SRHS

MIDAS Comparative

JCAHOHQI 8th Decile

HQI

100%98.84%

95.56%

82.76%

(162/164)(558/570) (165/166)(138/140)

Q3 FY 2006 Opportunities IdentifiedQ3 FY 2006 Opportunities Identified: (2 cases): (2 cases)

♥♥ Both cases patient received Beta blocker morning of discharge; hBoth cases patient received Beta blocker morning of discharge; however, not listed owever, not listed in physicianin physician’’s discharge summary nor Universal Medication Forms discharge summary nor Universal Medication Form

2424

ACE Inhibitor or ARB Prescribed @ DischargeACE Inhibitor or ARB Prescribed @ Discharge

ACUTE MYOCARDIAL INFARCTION (AMI) INITIATIVEACE INHIBITOR OR ARB PRESCRIBED AT DISCHARGE

(Q3 FY 2006)(JCAHO - HQA - CMS/Premier HQI- IHI)

92.31 91.667

91.429

72.97

73.58

68.29

80

87.6

86.1183.721

64.52

75.0

72.55

82.61

72.0

50

55

60

65

70

75

80

85

90

95

100

Q1 FY2003

Q2 FY2003

Q3 FY2003

Q4 FY2003

Q1 FY2004

Q2 FY2004

Q3 FY2004

Q4 FY2004

Q1 FY2005

Q2 FY2005

Q3 FY2005

FY 2005 Q1 FY2006

Q2 FY2006

Q3 FY2006

TIME FRAME

% C

OM

PLIA

NC

E

SRHS HQI Top 10% HQI Top 20% HQI: 5TH (MEDIAN)HQI:YEAR 1 BASELINE: 8th MIDAS COMPARATIVE JCAHO EXPECTED*

HQI

100%

95%

85.51%

66.67%

HQI 1st (Top) Decile

HQI Top 2nd Decile

HQI Top 50%

SRHS JCAHO

MIDAS Comparative

HQI 8th Decile

(32/40)

(113/129)

(32/35)(44/48)

Q3 FY 2006 Opportunities Identified:Q3 FY 2006 Opportunities Identified: (4 cases)(4 cases)

♥♥ Addressing reason for not prescribing an ACEI; however, not addrAddressing reason for not prescribing an ACEI; however, not addressing essing reason for not prescribing an ARB in renal patientsreason for not prescribing an ARB in renal patients

2525

Action: Encourage Physicians to Use:Action: Encourage Physicians to Use:HEO HEO -- Cardiac Discharge TemplateCardiac Discharge Template

ACC/AHA ACC/AHA GuidelinesGuidelines

2626

Smoking Cessation Advice/CounselingSmoking Cessation Advice/Counseling

ACUTE MYOCARDIAL INFARCTION (AMI) INITIATIVESMOKING CESSATION ADVICE/COUNSELING

(Q3 FY 2006)(JCAHO - HQA - CMS/PremierHQI - IHI)

100 100 100 100 100 100 100

99.1796.55295.5998.46

97.198.3694.7496.72

0

10

20

30

40

50

60

70

80

90

100

Q1 FY2003

Q2 FY2003

Q3 FY2003

Q4 FY2003

Q1 FY2004

Q2 FY2004

Q3 FY2004

Q4 FY2004

Q1 FY2005

Q2 FY2005

Q3 FY2005

FY 2005 Q1 FY2006

Q2 FY2006

Q3 FY2006

TIME FRAME

% C

OM

PLIA

NC

E

SRHS HQI Top 10% HQI Top 20% HQI: 5TH (MEDIAN)HQI:YEAR 1 BASELINE: 8th MIDAS COMPARATIVE JCAHO EXPECTED*

HQI 1st (Top) DecileHQI Top 2nd Decile

HQI Top 50%

SRHS

MIDAS Comparative

JCAHO

HQI 8th Decile

HQI

(86/86)

100%

(239/241)95.42%

61.11%

(78/78)(77/77)

Q3 FY 2006 Opportunities IdentifiedQ3 FY 2006 Opportunities Identified::

NONE, Met the StandardNONE, Met the Standard

2727

Titles/ETitles/E--Mail AddressesMail Addresses

♥♥ Susan Duggar, Interim Executive Director Heart Center/Interim CNSusan Duggar, Interim Executive Director Heart Center/Interim CNO O ((sduggar@srhs.comsduggar@srhs.com))

♥♥ Cheryl OCheryl O’’Hara, Clinical Director Emergency Center (Hara, Clinical Director Emergency Center (coharacohara@ @ srhs.comsrhs.com))

♥♥ Bonnie Hunter, Cardiology Clinical Outcomes Specialist Bonnie Hunter, Cardiology Clinical Outcomes Specialist ((bhunter@srhs.combhunter@srhs.com))

♥♥ JT Smith, Chest Pain Coordinator, (JT Smith, Chest Pain Coordinator, (jtsmith@srhs.comjtsmith@srhs.com))

♥♥ Margie Petty, Cath Lab Manager, (Margie Petty, Cath Lab Manager, (mlpetty@srhs.commlpetty@srhs.com))

♥♥ Karen Newton, Director of Quality Services, (Karen Newton, Director of Quality Services, (knewton@srhs.comknewton@srhs.com))

Questions????Questions????