1. Mission: Lifeline EMS Recognition 2016 Webinar
Wednesday, December 2, 2015

2. Panelists David Travis, Mission: Lifeline EMS Manager
Lee Garvey, MD, Carolinas Medical Center
Alex Kuhn, Senior Director, Quality and Systems Improvement
Ben Leonard, EMS Director, Mission: Lifeline/Quality Improvement Initiatives
Joshua Roberts, NRP, Susquehanna Valley EMS

3. EMS Recognition Application period will open January 1st and remain open through March 31st 2016
EMS Recognition remains focused on STEMI patients for Additional Measures for stroke and resuscitation may be added in the future.
Criteria for achievement for 2016 is the same as 2015
There are new reporting measures this year.

4. Today’s Webinar:
Dr. Garvey will discuss the importance of achieving First Medical Contact to Device times of 90 minutes or less.
Alex Kuhn will review the EMS Recognition program, the criteria, and the new reporting measures
Joshua Roberts will review the process his agency uses for gathering necessary data.
Ben Leonard will review the spreadsheet available for all agencies to use.
Open discussion and questions

5. The importance of FMC to device time for STEMI patients
Lee Garvey MD
Professor of Emergency Medicine
Carolinas Medical Center
Charlotte, NC

6. STEMI Point of Entry Protocol
Background
Hospital fibrinolysis: Door-to-needle within 30 min
FMC to device within 120 min
STEMI Point of Entry Protocol
STEMI-referral hospital (non PCI-capable)
Onset of symptom of STEMI
GOALS†
Patient
5 min after symptom onset
EMS on-scene • Obtain 12-lead ECGs • Consider prehospital fibrinolytic if capable and EMS-to-needle within 30 min
EMS on scene
EMS transport
within 8 min
Prehospital fibrinolysis: EMS-to-needle within 30 min
Inter-hospital transfer
STEMI-receiving hospital (PCI-capable)
EMS dispatch
Dispatch
1 min
EMS Triage Plan
Patient point-of-entry (POE) protocols should be developed with the understanding that a patient may call and be in an EMS zone that transports to a STEMI-referral or STEMI-receiving hospital. Also, patients may directly present to a non-PCI center and be in need of inter-hospital transfer or present to a primary PCI center.
The ACC/AHA guidelines encourage EMS on scene be equipped with 12-Lead ECG technology. Advanced systems may consider pre-hospital fibrinolysis, but the majority in the U.S. EMS should have a destination protocol in place.
[Note to Presenter: Following text from the 2004 Full Text STEMI ACC/AHA Guidelines caption (pg 19).]
Patient transported by EMS after calling
1: Reperfusion in patients with STEMI can be accomplished by the pharmacologic (fibrinolysis) or catheter-based (primary PCI) approaches. Implementation of these strategies varies based on the mode of transportation of the patient and capabilities at the receiving hospital. Transport time to the hospital is variable from case to case, but the goal is to keep total ischemic time within 120 minutes. There are three possibilities:
a) If EMS has fibrinolytic capability and the patient qualifies for therapy, pre-hospital fibrinolysis should be started within 30 minutes of EMS arrival on scene;
b) If EMS is not capable of administering pre-hospital fibrinolysis and the patient is transported to a non-PCI-capable hospital, the hospital door-to-needle time should be within 30 minutes for patients in whom fibrinolysis is indicated;
c) If EMS is not capable of administering pre-hospital fibrinolysis and the patient is transported to a PCI-capable hospital, the hospital door-to-balloon time should be within 90 minutes.
Inter-hospital transfer:
It is also appropriate to consider emergency inter-hospital transfer of the patient to a PCI-capable hospital for mechanical revascularization if:
1: There is a contraindication to fibrinolysis;
2: PCI can be initiated promptly (within 90 minutes after the patient presented to the initial receiving hospital or within 60 minutes compared to when fibrinolysis with a fibrin-specific agent could be initiated at the initial receiving hospital); fibrinolysis is administered and is unsuccessful (i.e.,"rescue PCI").
Secondary non-emergency inter-hospital transfer can be considered for recurrent ischemia.
Patient self transport:
Patient self-transportation is discouraged. If the patient arrives at a non-PCI capable hospital, the door-to-needle time should within 30 minutes. If the patient arrives at a PCI-capable hospital, the door-to-balloon time should be within 90 minutes. The treatment options and time recommended after first hospital arrival are the same.
EMS transport: EMS-to-balloon within 90 min
Patient self-transport: Hospital D2B within 90 min
Total ischemic time: Within 120 min*
* Golden Hour = First 60 minutes
©2011, American Heart Association

7. FMC for EMS Recognition
For the purposes of Mission: Lifeline EMS Recognition - First Medical Contact (FMC) is the time of eye to eye contact between the STEMI patient and the first caregiver. (Medical First Responder, Physician at a clinic, or EMS personnel).
When the Medical First Responder or physician at a clinic is the first caregiver at the patient’s side, and their time of initial contact with the patient is known, the eye to eye contact time between the patient and that first caregiver is preferred. For the patient to be included in the Mission: Lifeline EMS Recognition program, there must have been a prehospital 12 lead, but not necessarily performed by the first caregiver.

8. Regional Systems of STEMI Care, Reperfusion Therapy, and Time-to-Treatment Goals
IIa
IIb
III B
All communities should create and maintain a regional system of STEMI care that includes assessment and continuous quality improvement of EMS and hospital-based activities. Performance can be facilitated by participating in programs such as Mission: Lifeline and the D2B Alliance. I
IIa
IIb
III B
Performance of a 12-lead ECG by EMS personnel at the site of FMC is recommended in patients with symptoms consistent with STEMI.
9/18/2018
©2013, American Heart Association

9. Regional Systems of STEMI Care, Reperfusion Therapy, and Time-to-Treatment Goals
IIa
IIb
III A
Reperfusion therapy should be administered to all eligible patients with STEMI with symptom onset within the prior 12 hours. I
IIa
IIb
III A
Primary PCI is the recommended method of reperfusion when it can be performed in a timely fashion by experienced operators. I
IIa
IIb
III B
EMS transport directly to a PCI-capable hospital for primary PCI is the recommended triage strategy for patients with STEMI with an ideal FMC-to-device time system goal of 90 minutes or less.*
9/18/2018
©2013, American Heart Association

10. Prehospital ECGs and reperfusion times
Results
Prehospital ECGs and reperfusion times
Variable
Year
EMS direct to PCI centers
(n= 58,624)
2008
2009
2010
2011
2012
Pre-hospital ECG (%) 45 58 61 66 71
FMC to device (minutes)*
93 (77,111)
89 (74,108)
88 (72,106)
85 (70,104)
84 (68,102)
Transfer to PCI centers (n=47,404)
Door-in-door-out (minutes)*
76 (48,125)
71 (46,115)
66 (42,107)
64 (40,105) 62
(39,101)
First door to device (minutes)*
130 (101,181)
122 (98,164)
119 (93,161)
114 (90,153)
112 (89,151)
DOOR TO BALLOON IS
NO LONGER
the Measure to Watch
*median (25th, 75th percentile)

11. EMS: FMC to Device Appropriate dispatch/ response
Prehospital 12 lead ECG
Destination hospital protocol
Prehospital notification and activation of Cath Lab
Minimize scene time
Maximize SYSTEM use of transport time
Minimize ED time

12. STEMI Direct To Cath Protocol
EMS: FMC to Device
STEMI Direct To Cath Protocol

13. RAPID EKG CRITERIA Door to decision 10 minutes
 30 YEARS OLD with CHEST PAIN
(EXCLUDING OBVIOUS TRAUMA)
 45 YEARS OLD with:
Syncope
Weakness
Rapid Heart Beat / Palpitations
Difficulty Breathing / Shortness of Breath
Modified from: Graff L, Palmer AC, LaMonica P, Wolf S. Triage of patients for a rapid (5-minute) electrocardiogram:
a rule based on presenting chief complaints. Ann Emerg Med. December 2000;36:

14. EMS: FMC to Device Prehospital 12 lead ECG Method for STEMI Diagnosis
Paramedic read
Algorithm interpretation statement
Algorithm + Paramedic confirmation
Transmit for Physician read
Transmit to all decision makers – EM and cardiology

15. STEMI Cath Lab Activation
Appropriate
Activation
Cath Lab Visit
Symptoms resolved
ECG normalized
Patient expired
+ Occlusions
No Intervention
PCI
CABG
Normal arteries
Medical Mgt
Inappropriate
Activation
ED ECG
EMS ECG
Not Cath Lab
Candidate
Protocol Violations 6%
4.3%
4.6%
CLAR Results
15%
85%
65%
9.1%
3.5%
3.2%
2.1%
1.4%

16. Strategy to Optimize CCL Activation
- Emphasize need for ongoing ECG interpretation education
- Educate regarding Cath Lab Candidacy; integrate this into Activation Protocols
Definite CCL Candidate
Questionable CCL Candidate
Definite ECG STEMI
Activate Entire STEMI System
Questionable ECG STEMI
STAT Consult with Interventionalist

18. EMS: FMC to Device STEMI Transfers - DIDO Triage ECG within 10 minutes
Emergency physician activates system
Call for transfer
Transfer vehicle/ crew response
Limit barriers to move quickly
IV meds, Xrays, documentation

19. PCI Hosp. Transport Door in door out NYC System Q1 2015
Arrival at First Facility to Device, Median Time (minutes)
Transfer In for Primary PCI
PCI Hosp.
Transport
Door in door out

20. Mission: Lifeline Quality Achievement Measures
Alex Kuhn
Senior Director, Quality and Systems Improvement
Columbus, OH

21. Mission: Lifeline EMS Recognition 2015 Award Recipients
123 Bronze
239 Silver
85 Gold

22. Mission: Lifeline EMS Recognition Volume Requirements
BRONZE: A minimum of 75% compliance for each required measure.
Volume: at least 2 STEMI patients per reporting quarter with at least 4 STEMI patients in the 2015 calendar year.
SILVER: Aggregated annual score achieving a minimum of 75% compliance for each required measure.
Volume: at least 8 STEMI patients in the 2015 calendar year
GOLD: 2 calendar years achieving an annual Aggregate minimum of 75% for each required measure.
Volume at least 8 STEMI patients in the 2015 calendar year.
Must have achieved a SILVER Award in 2015
For Bronze, there are no changes regarding volume.

23. Pathways for Mission: Lifeline EMS Recognition
Individual
Single applicant.
Must transport and provide 12 Lead EKG
Must meet volume and performance criteria
Joint
Dual applicant
Must either provide transport or 12 Lead EKG
Both applicants are required to meet volume and performance criteria
Team
One applicant who is responsible for transport, 12 Lead EKG and volume/performance criteria
Allows the applicant to recognize services that provide valuable assistance
Common “Teams” are Medical First Responders (MFRs), non-transporting fire departments that do not have 12 lead EKG capabilities, etc.

24. What are the Achievement Measures?
Percentage of patients with non-traumatic chest pain > 35 years treated by EMS who get a pre-hospital 12-lead electrocardiogram
Percentage of STEMI patients with first (pre-hospital) medical contact to device time within 90 minutes (non-transfer)
Percentage of STEMI patients taken to a referral hospital who administers fibrinolytic therapy with a door to needle time within 30 minutes.

25. What is First Medical Contact?
For the purposes of Mission: Lifeline EMS Recognition - First Medical Contact (FMC) is the time of eye to eye contact between STEMI patient and the first caregiver. (Medical First Responder, Physician at a clinic, or EMS personnel). When the Medical First Responder or physician at a clinic is the first caregiver at the patient’s side, and their time of initial contact with the patient is known, the eye to eye contact time between the patient and that first caregiver is preferred. For the patient to be included in the Mission: Lifeline EMS Recognition program, there must have been a prehospital 12 lead, but not necessarily performed by the first caregiver.

26. For what measures should I submit data?
Transport Destination Protocols determine achievement measures required to complete:
Agencies with STEMI patients transported to STEMI Receiving Centers only
Reporting Measures #1 and #2 required
Agencies with STEMI patients transported to STEMI Referring Centers only
Reporting Measures #1 and #3 required
Agencies with STEMI patients transported to both STEMI Receiving Centers and STEMI Referring Centers
Reporting Measures #1, #2, and #3 required

27. Measure #1 - 12 Lead ECG Acquisition
INCLUSION CRITERIA:
Denominator
Number of Patients >35 years of age with c/c Non-Traumatic Chest Pain
Numerator
Number of the patients included in the denominator that had a Pre-Hospital 12 Lead ECG acquired

29. Measure #2 - FMC to Device Activation/Primary PCI < 90 Minutes
INCLUSION CRITERIA
Denominator
Number of Patients (18 years of age or over) with a STEMI noted on Pre-Hospital ECG
AND Were transported to a STEMI Receiving Center
AND Had Primary PCI Performed
Numerator
Number of patients in the denominator where the total time from Pre-hospital FMC to Device activation/Primary PCI was achieved in 90 minutes or less

31. FMC to Device Activation/Primary PCI < 90 Minutes
REPORTING OUTLIERS/APPLYING EXCLUSIONS
Report the number of patients, included in the denominator volumes, where the total time from pre-hospital FMC to device activation/Primary PCI was more than 90 minutes.
Using the outlier volume, identify the number of patients that experienced one or more of the allowable exclusions:
Delay caused by patient or family providing consent for treatment/transport
Delay caused by patient experiencing cardiac arrest and/or the need for intubation
Delay caused by difficulty in accessing femoral or radial artery (cath lab)
Delay caused by difficulty in crossing coronary lesion (cath lab)

32. Measure #3 - Arrival to Fibrinolytic Administration < 30 Minutes
INCLUSION CRITERIA
Denominator
Number of Patients (18 years of age or over) with a STEMI noted on Pre-Hospital ECG
AND Were transported to a STEMI Referring Center
AND Had Fibrinolytic Therapy Administered
Numerator
Number of patients in the denominator where the total time from Arrival at the Referring Center to Fibrinolytic Administration was achieved in 30 minutes or less

33. Arrival to Fibrinolytic Administration < 30 Minutes
REPORTING OUTLIERS/APPLYING EXCLUSIONS
Report the number of patients, included in the denominator volumes, where the total time from Arrival at the Referring Center to Fibrinolytic Administration was greater than 30 minutes.
Using the outlier volume, identify the number of patients that experienced one or more of the allowable exclusions:
Delay caused by patient or family providing consent for treatment/transport
Delay caused by patient experiencing cardiac arrest and/or the need for intubation

34. 2016 Reporting Measures
Optional (but encouraged) for 2016 award application
“Percentage of 12 lead ECGs performed on chest pain patients within 10 minutes of FMC”
“The time (in minutes) that 75% of hospital notifications are performed after the positive 12 Lead is captured”
Over-call activations
Under-call activations

36. ©2010, American Heart Association
9/18/2018

38. ©2013, American Heart Association
9/18/2018

41. Quick Prehospital ECG History
June 1967 The Miami Fire Department's, Station # 1 first transmitted E.C.G. recordings via radio waves from the field to the hospital.
1999 Guidelines – Prehospital Twelve-lead telemetry. (Class IIa, LOE B)
2004 Guidelines - It is reasonable that all ACLS providers perform and evaluate 12-lead ECGs routinely on chest pain patients suspected of STEMI. (Class IIa, LOE B)
2006 Pre-Hospital 12-Lead Electrocardiography Programs
A Call for Implementation by Emergency Medical Services
Systems Providing Advanced Life Support - NHAAP/NHLBI
2008 – 90% of largest 200 cities had 12-lad ECG capability
2015 Guidelines - Prehospital 12-lead ECG should be acquired early for patients with possible ACS (Class I, LOE B)

42. Level of certification Crew configuration Equipment availability
Factors impacting
Urban/Rural
(Urban 69.4% vs Rural 30.6%)
Race
(White 61.8% vs Black 57.2%)
Level of certification
Double the chance
Crew configuration
Basic vs Paramedic
Equipment availability

43. Is 99% Quality Good Enough?
22,000 checks will be deducted from the wrong bank accounts in the next 60 minutes.
20,000 incorrect drug prescriptions will be written in the next 12 months.
12 babies will be given to the wrong parents each day.

45. Mission: Lifeline Application Tool
Ben Leonard
EMS Director, Mission: Lifeline/Quality Improvement Initiatives
Cheyenne, WY

46. Joshua Roberts, NRP Operations Manager Lancaster, PA
STEMI Data Management
Joshua Roberts, NRP
Operations Manager
Lancaster, PA

47. Overview Necessary for trend analysis
Easily identify areas for improvement
Integration of existing software into data management saves hours of manual research and PCR review
Compiling data for tracking of core clinical cases, such as STEMI, Cardiac Arrest, CVA, and Trauma, are a key factor in an organization’s ability to identify trends and evaluate areas for improvement. With electronic documentation software becoming the norm across the nation, many agencies are utilizing the back end software components to capture the data. This comes as a huge time savings, sparing the user from opening up each case and manually documenting the data components desired.

48. Identification- Basic Information
Date & Day of event
Patient demographics
Municipality
Lead ALS provider(s)
The first step you must take is to identify what type of data you are looking for. Planning this out before tinkering with the software report system can make future data pulls quicker. First, establish the basics:
Date of event. If your software doesn’t convert the data into the actual day, you can use an Excel formula to make this happen. We use the actual day of the week to identify trends. It doesn’t necessarily have much effect on patient care, but it certainly can be disseminated to the providers on duty that today is generally a higher frequency day of STEMI.
Patient demographics- A last name will usually suffice along with the patient’s age. We use the patient’s last name as an easy reference to obtain outcome information from local PCI centers. The age is an important factor in trend analysis.
Municipality- Sometimes, obtaining this information can help you identify which areas of your response are at higher risk or have higher rates of STEMI. Community outreach programs can then be aimed more aggressively to these areas. In conjunction with other data, it may also assist with identifying response times and other factors that can lead to better outcomes by better placement of EMS units.
Lead ALS provider- This is simply for recognition efforts when awards/citations are issued, if your agency does this.

49. Identification: Event Times
Dispatch
Response
Patient contact
Transport
Receiving facility
Event times are a critical component to tracking every aspect of the call from start to finish. These include:
Time of dispatch
Time of response
Time of patient contact
Time of transport
Time at receiving facility
Between these various categories, you can identify the minutes between each component as necessary. Here is an example of our layout.

50. MIN= PATIENT TO HOSPITAL
Dispatch
Responding
Arrived Pt
MIN= 911 TO PATIENT
Transport
MIN= ON-SCENE
Arrived Hospital
MIN= 911 TO HOSPITAL
MIN= PATIENT TO HOSPITAL
17:18
19:19
17:28 10
17:36 8
17:57 39 29
14:03
14:11
14:37 26
14:57 54 46
13:18
13:33 15
13:52 19
14:22 64 49
12:57
13:21 24
13:40 43
20:45
20:47
20:59 14
21:32 33
21:48 63
19:04
19:15 11
19:36 21
19:54 50
14:49
14:51
15:03
15:21 18
15:38 35
7:27
7:29
7:38
7:49
8:06 28
14:14
14:15
14:23 9
14:54 31
15:05 51 42
14:08
14:09
14:18
14:32
14:50 32
16:55
16:57
17:08 13
17:32 37
9:20
9:21
9:25 5
9:34
9:51
11:55
11:57
12:03
12:23 20
12:32
17:58
18:00
18:07
18:19 12
18:38 40
2:05
2:08
2:13
2:27
2:40 27
13:29
13:30
13:38
14:05 36
Here is the basic layout of our time measurement. We performed calculations of how long it takes from the time of the 911 dispatch to patient contact, how long crews are spending on the scene, the time it takes from dispatch to arrival at hospital and the time of patient contact to arriving at the hospital.
Set up some basic parameters. You can use conditional formatting to quickly identify values outside of what’s expected, such as our minutes from 911 dispatch to patient contact. In these cases, we would pull that PCR and verify its accuracy as well as compare it to the fleet tracking system. Perhaps a crew forgot to update their status with the 911 center.

51. Identification: STEMI Factors
EMS STEMI type
Leads/Views obtained (12/15/18 lead EKG)
Receiving facility
First time of 12-lead
First time of EKG transmission
Aspirin
Finally, you will want to identify what you’re looking for as it relates to STEMI care. Here are some factors we use to identify areas for improvement and benefit patients overall.
EMS STEMI type- This is useful so QA managers can verify that providers are calling the right types of MI’s in the field. If the case turned out to not be a STEMI, it can be helpful to review with the provider why they called it a STEMI (such as a mimic) or other remediation as necessary.
12/15/18 lead acquired? -At a minimum, a 12-lead must be performed. You can also add what times other 12-leads were obtained if you require serial EKGs. In our case, any patient with an inferior presentation must have a 15-lead (V4R-V6R) obtained, and any patient with suspected posterior involvement will have an 18-lead obtained.
Which hospital was the patient taken to? -This can be used simply to identify if the patient went to an appropriate PCI center or not.
When was the first 12-lead obtained -You can measure this to ensure that the recognition of STEMI is done quickly. Our providers are required to obtain a 12-lead within 10 minutes of patient contact, and transmission of suspected STEMI cases in 2 minutes of obtaining.
Was ASA given? If so, what time? -As we all know, ASA is a key component to patient care. Therefore, you want to measure when ASA was given (if given) and set a time frame. In Pennsylvania, EMTs and Paramedics both can give Aspirin; therefore we require it to be given in any suspected ACS case within 5 minutes.
Our set-up is shown next.

52. EMS STEMI TYPE
15 Lead?
18 Lead?
Anterolateral
Inferior/RVMI
YES
Inferoposterior NO
Inferior
Septal
Anteroseptal
Lateral
Anterior
This is what type of STEMI the EMS provider has documented. Based on the type, conditional formatting is assigned to the 15 & 18-Lead cells to identify which patients are required to have additional views.

53. 1ST 12-LEAD ACQUIRE TIME
MIN= CONTACT TO 12-LEAD
12-LEAD TRANS-MITTED?
1ST 12-LEAD TRANS- MISSION TIME
MIN= ACQUIRE TO TRANSMIT
MIN= CONTACT TO TRANSMIT
ASA Given?
ASA TIME
MIN= CONTACT TO ASA
23:06 8
YES
23:16 10 18
23:08
14:54 7
14:56 2 9
14:55
15:23
15:29 6 13
15:37 21
16:54 NO
16:56 4
4:11
4:29 25
4:10
7:24
7:33
7:26
11:28
11:29 1
11:24
12:06
12:13
12:11 11
15:07
15:21 14 22
15:08
5:47
5:55
5:50
1:58
1:57 5
7:40
7:45
7:58 24
11:48
11:52
11:50
8:23
8:24
9:41
9:45 12
9:54
19:48
19:49
7:37
7:39
7:36
This is the data table for various STEMI elements capture. Again, with conditional formatting, you can ensure each parameter is met on every patient.

54. Quality Assurance/Improvement
Planning is the key- early identification of goals
Use data capture to identify target areas:
12-lead obtain & transmission times
Time of ASA administration
On-scene times
Additional views for varying presentations
Accuracy of field interpretation
Planning is always the key to a successful STEMI management system. Identifying your goals from the beginning and building the system based on these goals will help you concentrate the development and implementation efforts without losing focus. Once you have the data built, incorporating quality assurance & improvement into the STEMI system is rather easy. Conditional formatting of your data sheet will quickly identify the parameters that were not met. Some examples of these include:
Time of 12-lead & transmission
Time of ASA administration
On-Scene time
Additional lead views for varying presentations
Field accuracy of interpretation

55. This is a sample QA worksheet that our organization’s Field Training Officers use for every single call that is put through the QA/QI process. This ensures that all patients have data documented in the same manner. For various conditions, our software allows you to obtain more details information regarding the ACS case.
There is one person assigned to oversee all ACS reports that come in. They go over the details of the PCR to ensure compliance to organizational standards and protocols. Another piece of information that they have at their disposal is the actual transmitted EKG. Any 12-lead that is transmitted to a receiving facility comes thru our company server to the Education Manager in the same format that the hospital would receive. The EKGs are also part of the PCR when uploaded from the monitor into the reporting software.
When there is a Code-R case that went well, we notify the organization and give kudos to the crew involved. They are also recognized at a yearly banquet where they get a lifesaving citation and certificate. When there are issues with the call, the FTO will flag this for medical review. Medical Review requests go to a Medical Advisory Board, made up of an EMS Captain, Lieutenant, ALS & BLS FTO, Medical Director, and Chief of Operations. This is where the final determination is made as to remediation by the provider’s platoon Captain or more formal discussion in-person w/ the Medical Director.

56. Obtaining data from the hospitals is rather easy, once the process is set up. Each hospital has their own method of disseminating information to local EMS agencies. Fortunately for us, we only have 2 hospitals who are PCI capable within 20 miles of our first due, so the data is pretty consistent.
This is one of the data sheets that we receive. The information is mostly visual in nature, which our providers can easily see how the various processes measured up to the standards set.

57. Code R FEEDBACK
Exam Date 9/6/2015 TW
Cardiologist Name Dr. Singh
ED Physician Name Dr. shah, Ankit
ED Present Time 09:27
STEMI or new LBBB on ECG? Yes
911 Dispatch call 08:50
1st Contact with Pt (EMS) 09:00
Time of 1st ECG 09:08 EMS EKG
Time Code R Called 09:15
Minutes from ECG until Card Paged 2 min.
Minutes from page until Cardiologist Bedside min.
Time CCL Called (Call 1 receives page) in house
Total Time from Call 1 page until Room Ready room ready.
Time of Arterial Access 10:03
Time Wire Across Lesion 10:17
Time Balloon inflated or Thrombectomy Performed 10:20
Total Reperfusion Time (minutes) 53 min.
Procedure DES placed in totally occluded RCA
Here is another data sheet from the other PCI center. This is pretty cool that they can get the first and last images when performing the procedure.

58. Conclusion Identify goals up front Work with software developer
Customize your data
Training & implementation
Constant monitoring
So, setting up the STEMI process is not that difficult. Appropriate planning and goal identification will pretty much lead the way as it relates to how you proceed. Working with your PCR software vendor to create custom reports is the key to pulling data and making sure your software works for you.
Unfortunately, we have not found a tried and true method of simply pulling software data into our current data management worksheet, this is done manually. In our situation, the software does not allow you to customize your reports to be that specific.
The follow through of the call is of key importance. Measuring your organizational goals against what is actually happening in the field and constant monitoring of the process will ensure that each potential or recognized STEMI gets the same optimal care.

59. Questions?