National AMI Information Call February 5, 2008 Patient Safety Initiative.

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National AMI Information Call February 5, 2008 Patient Safety Initiative

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Transcript of National AMI Information Call February 5, 2008 Patient Safety Initiative.

Page 1: National AMI Information Call February 5, 2008 Patient Safety Initiative.

National AMI Information CallFebruary 5, 2008Patient Safety Initiative

Page 2: National AMI Information Call February 5, 2008 Patient Safety Initiative.

Elements of AMI bundle• Early administration of aspirin• Aspirin at discharge• Beta-blocker at discharge• ACE-inhibitor or angiotensin receptor

blocker at discharge

Page 3: National AMI Information Call February 5, 2008 Patient Safety Initiative.

Elements of AMI bundle• Timely reperfusion (thrombolysis or

percutaneous intervention)• Smoking cessation counseling

Page 4: National AMI Information Call February 5, 2008 Patient Safety Initiative.

Today’s focus:• Issues and opportunities related to

capturing and improving the timing of AMI care at the receiving hospital and the tertiary PCI centre

Page 5: National AMI Information Call February 5, 2008 Patient Safety Initiative.

Southlake Regional Health Centre• 323 bed hospital in Newmarket,

Ontario• Regional Cardiac Care Program• Advanced services: Interventional

Cardiology, Cardiac Surgery and Heart Rhythm Programs

Page 6: National AMI Information Call February 5, 2008 Patient Safety Initiative.

Successful strategies to improve AMI and timely PCI• Early repatriation of PCI patients back to referring hospitals• Increased availability of cath lab and interventional team

(expanded working hours)• Regional PCI guidelines developed and disseminated to

regional partners• Primary PCI implemented within SRHC

Page 7: National AMI Information Call February 5, 2008 Patient Safety Initiative.

Successful strategies to improve AMI and timely PCI

• Implementation of regional STEMI bypass program• Dedicated data analyst for PCI data• Ongoing collaboration with our own ER department and

with regional partners

Page 8: National AMI Information Call February 5, 2008 Patient Safety Initiative.

Challenges• Number of advanced vs. primary paramedics in region• Cost of equipment: technology to transmit ECG’s from

ambulance • Cath lab in use• Bed availability and patient flow• Efficient use of PCI unit

Page 9: National AMI Information Call February 5, 2008 Patient Safety Initiative.

AMI

7.0 Perfect Care for AMI

0%

20%

40%

60%

80%

100%

120%

Month

Perc

en

tag

e

Actual Goal

Page 10: National AMI Information Call February 5, 2008 Patient Safety Initiative.

The Credit Valley Perspective

• Credit Valley Hospital is a 383 bed community hospital

• 360 patients admitted with acute myocardial infarction (AMI) in 2006/2007

Page 11: National AMI Information Call February 5, 2008 Patient Safety Initiative.

AMI Data• 139 subendocardial myocardial

infarctions admitted• 113 admitted to CCU• 102 transferred to other facility for

coronary intervention

Page 12: National AMI Information Call February 5, 2008 Patient Safety Initiative.

In the Beginning…• EFFECT study (1999-2004)• Retrospective chart review of AMI patients• 135 charts audited• Quality indicators included risk factor reduction,

‘door to needle time’, aggregate secondary prevention

(ICES/CCORT, 2004)

Page 13: National AMI Information Call February 5, 2008 Patient Safety Initiative.

EFFECT Study• Current practice in the ER is to use

pre-printed physician orders and the A.C.T. team for all AMI patients

Page 14: National AMI Information Call February 5, 2008 Patient Safety Initiative.

PCI or TnK??• No percutaneous coronary intervention facility on

site at Credit Valley Hospital for primary PCI• Treatment delays a risk when transferring to

other facility for primary PCI• Pharmacotherapy the best choice for STEMI

patients• Facilitated PCI (TRANSFER-AMI)

Page 15: National AMI Information Call February 5, 2008 Patient Safety Initiative.

STEMI Data 2007 (Jan to June)• SHN goal 85% of patients with door to needle

time < 30 min• Average time for January 2007 to June 2007 was

37.4 minutes (median 28.5)• 54% of CVH patients had door to needle time <

30 min

Page 16: National AMI Information Call February 5, 2008 Patient Safety Initiative.

Challenges…• Time to ECG• Changing cardiac patient population• Transportation issues

Page 17: National AMI Information Call February 5, 2008 Patient Safety Initiative.

Opportunities• Regionalized care for AMI patients requiring

interventions• Improved transfer protocols with an organized,

patient centered focus• Enhanced communication and documentation

Page 18: National AMI Information Call February 5, 2008 Patient Safety Initiative.

Questions?

Thank you for your interest in SHN!

Amanda Darwood RN BSc , Southlake Regional Health Centre

Rachel French RN, Credit Valley Hospital


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