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National AMI Information Call February 5, 2008

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. Elements of AMI bundle.

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National AMI Information Call February 5, 2008

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  1. National AMI Information CallFebruary 5, 2008 Patient Safety Initiative

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

  3. Elements of AMI bundle • Timely reperfusion (thrombolysis or percutaneous intervention) • Smoking cessation counseling

  4. 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

  5. Southlake Regional Health Centre • 323 bed hospital in Newmarket, Ontario • Regional Cardiac Care Program • Advanced services: Interventional Cardiology, Cardiac Surgery and Heart Rhythm Programs

  6. 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

  7. 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

  8. 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

  9. AMI

  10. The Credit Valley Perspective Credit Valley Hospital is a 383 bed community hospital 360 patients admitted with acute myocardial infarction (AMI) in 2006/2007

  11. AMI Data • 139 subendocardial myocardial infarctions admitted • 113 admitted to CCU • 102 transferred to other facility for coronary intervention

  12. 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)

  13. EFFECT Study • Current practice in the ER is to use pre-printed physician orders and the A.C.T. team for all AMI patients

  14. 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)

  15. 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

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

  17. Opportunities • Regionalized care for AMI patients requiring interventions • Improved transfer protocols with an organized, patient centered focus • Enhanced communication and documentation

  18. 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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