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Time Critical Diagnosis

Time Critical Diagnosis. 9-1-1 COORDINATION WORKGROUP Samar Muzaffar, MD MPH. The Public Health Model as a Foundation. Missouri’s Goals: Reduce incidence and severity of injury, stroke, and STEMI Improve access into the system Improve outcomes of those injured or suffering stroke and STEMI

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Time Critical Diagnosis

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  1. Time Critical Diagnosis 9-1-1 COORDINATION WORKGROUP Samar Muzaffar, MD MPH

  2. The Public Health Model as a Foundation • Missouri’s Goals: • Reduce incidence and severity of injury, stroke, and STEMI • Improve access into the system • Improve outcomes of those injured or suffering stroke and STEMI • Improve system evaluation and QA/QI/PI Processes

  3. The Public Health Model as a Foundation • Missouri’s Key Guiding Principles • Patient centered care • Evidence-based system design • Population-based approach • Evaluation mechanism

  4. The Circle

  5. Epidemiology in Missouri Leading causes of death: 1st Heart Disease, including ST-Elevation Myocardial Infarction (STEMI) 4th Stroke 1st/5th Trauma-injury-accidents, motor vehicle accidents, suicide, homicide, other; Leading cause of YPLL

  6. TRAUMA • Trauma is the first or fifth leading cause of death in Missouri depending on group. • It is the most frequent cause of visits to the emergency department, causing more than half a million visits in 2006. • Injuries account for the second highest total for inpatient hospital charges – $2 billion in 2006. • Compared to the entire United States, Missouri has • lower rates of emergency department visits for all three major categories of injuries – accidental, assault and self-inflicted • death rates from injuries that exceed the national rates for accidental injuries, suicides, falls, and motor vehicle injuries. • Missouri’s death rates for unintentional injuries have increased 25 percent between 1991 and 2006 • There are gaps, particularly in rural areas of Missouri, for timely access to a trauma center.

  7. STROKE • Stroke is now the fourth leading cause of death in the state. • In 2004, Missouri’s stroke death rate was 11 percent higher than the national rate. • Missouri ranked low (40 out of 52) in the comparison of stroke death rate between states. • Missouri was ranked 7th in stroke prevalence. • Only a small percent of ischemic stroke patients get definitive care within the 3 hour window recommended.

  8. STEMI • Heart disease, including STEMI, is the leading cause death in this state. • In 2004, Missouri’s heart disease death rate was 13.5 percent higher than the national rate. • Missouri was in the bottom ten (45 out of 52) in coronary heart disease death rates. • The prevalence of heart disease was higher than the national average • Missouri ranked 9th among the 50 states in heart disease prevalence in 2005.

  9. The Trauma System as a Model for Time Critical Events Trauma System: • Improves Patient Outcomes and Saves Lives • 50% reduction in preventable death rate after implementation • Decrease in cases of sub-optimal care from 32% to 3% • Improves Hospital Outcomes • Better outcomes compared to voluntary system • Cost Savings through more efficient use of resources • Improves Regional Outcomes • Regional system accommodates regional and local variations

  10. STROKE Prompt treatment reduces death and disability. STROKE • t-PA Treatment within 180 minutes from symptom onset: • Better odds of improvement at 24 hours • Improved 3-month outcome • Patients treated after 180 minutes • Poorer outcomes • More hemorrhages

  11. STEMI Prompt treatment reduces death and disability. STEMI • Shorter time from door-to-balloon (PCI) - lower risk of mortality • Moving towards first medical contact to balloon • Symptom onset to treatment time greater than 4 hours independent predictor of one-year mortality • Faster treatment and lower in-hospital mortality associated with hospital “specialization” and emphasis on PCI as principal mode of reperfusion

  12. Implementation: Progress and Goals Developing the System: August 2008: TCD Stroke/STEMI Task Force compiled formal recommendations Sept.’08-May ‘11: TCD Trauma Task Force convened and compiled recommendations 2008-Present: Stroke and STEMI Implementation groups met regularly and compiled standards for stroke and STEMI center designation and EMS

  13. 911 Coordination System Work Group Work Group: • 911 Partners • EMS Partners • Hospital Discuss: • Shared Processes • TCD System Coordination Develop Shared Guidance

  14. Workgroup Outcomes • An understanding of system operations, requirements, demands, and constraints for 911/PSAP partners • An understanding of how the 9-1-1/PSAP's, EMS, and hospitals can build on existing coordination, collaboration, and integration with one another • Consensus and guidance around PAI and EMD for TCD patients • Identification of key data elements for 9-1-1/PSAP for inclusion in the TCD registry • Identification and/or development of key education messages and resources for 9-1-1/PSAP's for trauma, stroke, and STEMI patients

  15. Workgroup Outcomes • Identification of resource gaps and needsfor time critical patient processes • Guidance for dispatch, time window goals, and options to strive towards meeting those goals as identified in state or community plan for time critical patients • Identification of potentially shared resources, for example, educational resources • Recommendations for incorporating 9-1-1/PSAP's into quality assurance functions that should be done on local, regional, and state level • Recommendations for specific training and supports

  16. The End Goal:

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