Cox, David A, MD

Feldman, Bruce, DO

Freudenberger, Ronald S, MD

Kleaveland, J Patrick, MD

Patel, Nainesh, MD

Richardson, David M, MD

Rios-Scott, Mercedes, BS

Rivera, Orlando E, RN

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of MedicineST-Segment Elevation (STEMI) Real Time DataFeedback –A Process of Care InitiativeOrlando E. Rivera RNLehigh Valley Health Network, Orlando_E.Rivera@lvhn.orgNainesh Patel MDLehigh Valley Health Network, nainesh_c.patel@lvhn.orgBruce Feldman DOLehigh Valley Health Network, bruce.feldman@lvhn.orgMercedes Rios-Scott BSLehigh Valley Health Network, Mercedes.Scott@lvhn.orgDavid M. Richardson MDLehigh Valley Health Network, David.Richardson@lvhn.orgSee next page for additional authorsFollow this and additional works at: http://scholarlyworks.lvhn.org/medicinePart of the Cardiology Commons, Emergency Medicine Commons, and the Medical SciencesCommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtRivera, O., Patel, N., Feldman, B., Rios-Scott, M., Richardson, D., Kleaveland, J. Cox, D., & Freudenberger, R. (2013, April 24). ST-segment elevation (STEMI) real time data feedback - a process of care initiative. Poster presented at: The Society of Cardiovascular PatientCare (SCPC) 2013 Congress, Orlando, FL.AuthorsOrlando E. Rivera RN, Nainesh Patel MD, Bruce Feldman DO, Mercedes Rios-Scott BS, David M.Richardson MD, J Patrick Kleaveland MD, David A. Cox MD, and Ronald S. Freudenberger MDThis poster is available at LVHN Scholarly Works: http://scholarlyworks.lvhn.org/medicine/235 Lehigh Valley Health Network, Allentown, PennsylvaniaST-Segment Elevation (STEMI) Real Time Data Feedback –A Process of Care InitiativeOrlando Rivera RN; Nainesh C. Patel MD; Bruce Feldman DO; Mercedes Rios Scott BS; David Richardson MD; J Patrick Kleaveland MD; David Cox MD; Ronald Freudenberger MDAbstract: (Background / Objectives)Early identification of ST-Segment elevation Myocardial Infarction (STEMI) patients and prompt treatment aimed at reducing door-to-balloon time has been associated with reduction in mortality. 1 In order to further improve our STEMI process of care at Lehigh Valley Health Network, we reviewed a study by Bradley et al outlining six strategies for improving door-to-balloon (D2B) time in the STEMI patient population. 2 Following review of the literature we sought to add a process for real-time data feedback, as discussed by Bradley.  We believed timely feedback would strengthen our collaboration with emergency medical services (EMS), and improve long term STEMI outcome.Figures© 2013 Lehigh Valley Health NetworkMethods: A standardized method of data collection and communication with a report card that contained information about each patient’s care was created and implemented.  The process included the appointment of a dedicated person (ACS Program Coordinator) responsible for the real-time feedback process, and the creation of an IRB-approved semi-automated Myocardial Infarction (MI) Alert database (Figure 1).  This allowed for consistent and real-time (within 24 hours) data feedback generation.  The real-time feedback process was implemented on April 1, 2009.  Feedback, in the form of a report card, was provided to our EMS partners, Emergency Department (ED) nurses and physicians, as well as the cardiac catheterization lab nurses and technologists. Their performance during a STEMI emergency was documented, emphasizing time to diagnosis, treatment and patient outcome.  Two versions of the report were implemented, the Hospital version (Figure 2), and the EMS version (Figure 3).We performed a retrospective review of STEMI patients arriving to the ED between July 1, 2006 and March 31, 2013.  Patients were stratified two ways - by the pre and post implementation of the real-time feedback process and the source of activation of the STEMI process of care (ED vs. EMS).  Conclusion: Real-time feedback provided within 24 hours of patient arrival with STEMI was successful in reducing D2B time and improving long term clinical outcomes.  Post implementation, the volume of EMS STEMI activations increased by 95.37%. One of the most beneficial outcomes from this process was improved communication with all members of the STEMI process of care team, including administrators, physicians, nurses, technologists, and EMS.  A successful feedback process requires a dedicated person responsible for Results:(Table 1)•  Between July 2006 and March 2013 a total of 1,635 STEMI patients were treated, of the total patients treated 1,385 (84.70%) received percutaneous coronary intervention (PCI).    •  The ED activated the STEMI process for 1,040 (63.60%) patients.  •  EMS activated the STEMI process for 595 (36.39%) patients. (Figure 4)•  Post implementation of the real-time feedback process, an Increase on STEMI patient volume was observed for the EMS group (95.37%). (Figure 5)•  Post implementation, a reduction of median D2B time for ED STEMI activations was observed (76 minutes (n=364) pre and 63 minutes (n=486) post).•  Post implementation, a reduction of median D2B time for EMS STEMI activations was observed (45 minutes (n=139) pre and 41 minutes (n=395) post). (Figure 6)•  Lower D2B times have contributed to falling long term STEMI mortality rates. data collection and distribution. Providing an accurate, consistent, and timely feedback report will maximize the opportunity for reducing time to treatment and improving long term patient outcome.  Our findings suggest that a real-time feedback process can be beneficial for hospitals looking to improve their STEMI process of care, improve long term STEMI patient outcomes, increase pre-hospital STEMI patient volume, and strengthen collaboration with EMS.References:1.	 	Rathore	SS,	Curtis	JP,	Chen	J,	et	al.	Association	of	door-to-balloon	time	and	mortality	in	patients	admitted	to	hospital	with	ST	elevation	myocardial	infarction:	national	cohort	study.		BMJ	2009;338:b18072.	 	Bradley	EH,	Herrin	J,	Wang	Y,	et	al.	Strategies	for	reducing	the	door-to-balloon	time	in	acute	myocardial	infarction.	N	Engl	J	Med	2006;	355:	2308-2320.%DeceasedFY20081.81.61.410.80.60.40.201.67Within 1 Mo of Discharge1.2FY2009 FY2010 FY2011 FY2012Within 6 Mo of Discharge Within 1 Yr of Discharge1.2501.4300.380.360.410.820.74STEMI Activation SourceTotal (Volume) No PCIBefore ImplementationAfter ImplementationVolume PercentChange (Adjusted)D2B Change(Minutes)Total VolumeD2B (Minutes)Total VolumeD2B (Minutes)All Combined 1635 251 503 71 881 65 20.42% -6EMS 595 61 139 45 395 41 95.37% -4ED 1040 190 364 76 486 63 -8.21% -13Figure 1. MI	Alert	Database Figure 2. Real-time	Feedback	Report(Hospital Version)	Figure 3. Real-time	Feedback	Report(EMS Version)	Figure 4. Effects	of	Real-time	Feedback	on	Pre-Hospital	STEMI	Volume(July 2006 through March 2013)139396Prior to Apr 2009 Implementation Post Apr 2009 ImplementationPre-Hospital Volume (Percent Change Increase of 95.37%4504003503002502001501005004563Before After807060504030201007641Pre-Hospital D2B Walk-In D2BFigure 5. Effects	of	Real-time	Feedback	on	Door	to	Balloon	Times(July 2006 through March 2013)Figure 6. Longterm	STEMI	Mortality	RateFY2008	through	FY2013 (July - March)Table 1.

ST-Segment Elevation (STEMI) Real Time Data Feedback –A Process of Care Initiative

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ST-Segment Elevation (STEMI) Real Time Data Feedback –A Process of Care Initiative

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