1. Key Indicator Components % ASA within 24 hrs of admission % ASA within 24 hrs of admission Reperfusion time (STEMI) Reperfusion time (STEMI) Door to needle (target ≤ 30 minutes) Door to needle (target ≤ 30 minutes) Door to balloon (target ≤ 90 minutes) Door to balloon (target ≤ 90 minutes) Medications ordered at discharge (contraindications noted) Medications ordered at discharge (contraindications noted) ASA, Beta Blocker, Ace Inhibitor or Angiotensis Receptor Blocker, Statins ASA, Beta Blocker, Ace Inhibitor or Angiotensis Receptor Blocker, Statins Smoking cessation advice for patients who are current smokers Smoking cessation advice for patients who are current smokers Referral to Cardiac Rehabilitation (SMH program) Referral to Cardiac Rehabilitation (SMH program)

2. Methodology / Approach Collected 5 months of baseline data (April to August 2006) Collected 5 months of baseline data (April to August 2006) First improvement target was Door-to-ECG time (using Lean Health methodology – 2006; partial implementation started early 2007) First improvement target was Door-to-ECG time (using Lean Health methodology – 2006; partial implementation started early 2007) Application for PHSA funding (approved June 07) Application for PHSA funding (approved June 07) Established Steering Committee and task groups (July 2007) Established Steering Committee and task groups (July 2007) Seconded a Data Coordinator Seconded a Data Coordinator Monthly meetings with Steering Committee and working groups Monthly meetings with Steering Committee and working groups Regular PDSA cycles Regular PDSA cycles

3. Interdisciplinary STEMI Team Cardiologists AMI / STEMI Coordinator ER Physicians ER Nurses (Triage & Educator) BCAS Supervisors ECG Technicians / Supervisor Program Director

4. Achievements to Date Strong culture of quality improvement Strong culture of quality improvement Program and administrative support Program and administrative support Active STEMI steering committee Active STEMI steering committee Pre-printed STEMI orders for ED (2006) Pre-printed STEMI orders for ED (2006) ED Education roll-out for STEMI identification at Triage ED Education roll-out for STEMI identification at Triage Baseline data for 2006 and 2007 Baseline data for 2006 and 2007 Data collection for full fiscal year 2007/08 Data collection for full fiscal year 2007/08

5. Achievements (cont’d) “Unofficial” expedited processes for ED (i.e. STEMI patient to stay on stretcher) “Unofficial” expedited processes for ED (i.e. STEMI patient to stay on stretcher) Improved STEMI documentation Improved STEMI documentation Partnership (VC, EHS, FH) in pre-hospital ECG project. Partnership (VC, EHS, FH) in pre-hospital ECG project. Measurable improvements in timeliness and quality of STEMI patient care Measurable improvements in timeliness and quality of STEMI patient care

10. N = 1 (or 0) Thrombolytic per month, interpret with CAUTION.