Regional ShowcaseWest Tennessee

Speakers: John Baker M.D./Emily Garner RNPresentation: Regional Showcase – West Tennessee

Presenter Disclosure Presenter Disclosure InformationInformation

•FINANCIAL DISCLOSURE:No relevant financial relationship exists

Jackson Madison County General Jackson Madison County General HospitalHospital

The flagship of West Tennessee Healthcare is a 635-bed tertiary care center.  The only tertiary care hospital between Memphis and Nashville, the hospital serves a 17-county area of rural West Tennessee. Approximately 551,000 persons reside within the service area. Within General Hospital, there exists six 'centers of excellence': the West Tennessee Heart and Vascular Center, Kirkland Cancer Center, West Tennessee Women’s Center, West Tennessee Rehabilitation Center, West Tennessee Neuroscience and Spine Center, and Emergency Services. Each center has an historic reputation of 'high-tech, high-touch' skills.

WTH Service Area2014 Population

Primary Service Area

Madison County 102,515Gibson County 49,467Carroll County 30,095Henderson County 28,390Hardeman County 30,607Crockett County 15,494Chester County 17,179Haywood County 19,851Subtotal 293,598

Secondary Service Area

McNairy County 26,604Hardin County 27,236Decatur County 11,519Henry County 33,002Weakley County 34,045Benton County 16,833Dyer County 39,450Obion County 32,935Lauderdale County 28,918Lake County 7,391Subtotal 257,933

Total Population 551,531

Primary Service Area

Secondary Service Area

.8

.9 .10

.7 .2.4

.1.5

.6

.13.12

.11.3

LAKE OBIONWEAKLEY

HENRY

STEWART

DYER

GIBSON HUMPHREYS

LAUDERDALE

CROCKETT

MADISON

HENDERSON

PERRY

TIPTON

HAYWOOD

CHESTER

HARDINMCNAIRY

HARDEMAN

FAYETTESHELBY

HOUSTON

DECATUR

BENTONCARROLL

WAYNE

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West Tennessee SystemWest Tennessee System

Cardiac Coverage Area•18 Counties

Hospitals•16 Acute Care Hospitals •2 PCI Receiving Facilities •1 PCI Receiving Facility with CV Surgery Back-Up

EMS Systems•17 Ground EMS Services•10 Air EMS Bases (between 2 Different Air Services)

.

Measure Initial State

Door to EKG Completion 21% of all cases = 5 minutes50% of STEMIs = 5 minutes

Door to STEMI Diagnosis 70% of cases = 10 minutes83% of STEMIs = 10 minutes

Door to Cath Lab Activation 74% of cases = 15 minutes

Door to Arrival CCL Team 83% of cases > 40 minutes

Door to Device Deployment (Door to Balloon Time)

35% of cases ≤ 90 minutes

JMCGH STEMI Mortality Rate 25%

Initial StateInitial State

Target StateTarget State

Chest Pain patient arrives

ECGdone STEMI?

No

Yes

EDActivatesCCL

CCL Member 1arrives

PatientMoved toCCL with2 ED Nurses

CCL Member 2arrives

Chest Pain Unit for obs

PatientPrepped

PatientTransferred FromStretcher to table

CCL Member 3 & Cardiologistarrives

Arterial Access By MD

Balloon Inflated

ED – ECGGoal: 10 min

ECG - CCLGoal: 45 min

CCL - BalloonGoal: 35 min

New Process for STEMI Patients

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Where We Started Where We Started Q32011Q32011

ChallengesChallenges

• Education – Hospital Administration, ED, EMS, Nursing• Rural Based Areas – long travel times (selection of transport mode)• Transmitting EKGs - Funding• STEMI Walk-Ins – Community Education on Calling 911• Preparation Time – Door In Door Out Times• ED Accepting Transfers• Communication/Data Feedback

SuccessesSuccesses

Education to all West TN Hospitals and EMS Systems

oGuidelines/TimesoEarly Recognition/TrainingoEarly Activation of TransportoEKG Transmission/Fax

Development of Co-Management Contract with Cardiologist

Annual STEMI 12 Lead EKG Training oProgram with Med Center EMS, Air Evac Lifeteam

SuccessesSuccesses

Quarterly Regional STEMI/Chest Pain Center Accr. Meetings

oWeb/Conference AvailableoMonthly Internal Meetings

Network Visits – Building Relationships is KEY!

Auto Accept/One-Call Policy

Resources Conference Calls for TransfersCommunity STEMI DrillsFeedback Data10-10-10 PlanSTEMI Treatment Zones/Map

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SuccessesSuccesses

Collaborating with other Facilities for their CPC Accreditation

Community Education on Signs/Symptoms/Calling 9-1-1

Events/Ads Importance of Bystander CPR – Pulse Point Free App Survive Don’t Drive Campaign - https://www.youtube.com/watch?feature=player_detailpage&v=dQH8LfbzmtM

Source: NCDR Registry – PCI - Metric #16Owner: W.TN Heart & Vascular Center

50th = 59.2mins

90th = 47mins

Source: NCDR Registry – Action - Metric #6Owner: W.TN Heart & Vascular Center

50th = 107mins

90th = 80mins

Source: NCDR Registry – PCI - Metric #18Owner: W.TN Heart & Vascular Center

50th = 44.8mins

90th = 27.8mins

Achievements/AwardsAchievements/Awards

2014 Women’s Choice Award for Best Heart Care

Based in performance in the following categories:•America’s Best Hospitals for Heart Failure Care•America’s Best Hospitals for Heart Attack Care•America’s Best Hospitals for Patient Satisfaction

2014 NCDR/ACTION Platinum Performance Achievement Award

Remaining ChallengesRemaining Challenges

Delayed Times in DD2B/DIDO

Outside Limited Resources

ED Physician Turnover

EMS FMC to PCI <90 minutes – Mission Lifeline Recommendation

Contact Info:Contact Info:

emily.garner@wth.org

jbaker@jacksonclinic.com