1. Overcoming the Hurdles: Improving DTB in the LVHHN MI-Alert Program Richard S. MacKenzie, MD, FACEP Chair Department of Emergency Medicine Lehigh Valley Hospital & Health Network A HOSPITAL AND HEALTH NETWORK L EHIH V o LLEY

2. Problem at the Millenium n Inconsistency n Mortality 5-7% PCI n Mortality lytic 6-16% EUR HEART J. 2002 23 550

4. PSIMT n Plan l Problem identification & clarification l Solution identification & clarification l Presentation for input n Do l Implement - education precedes date l Presentation for understanding

5. PSIMT (2) n Study - Monitor for… l “protocol violations” l anecdotes l Trends n Act – Tweak the process

6. D2B Specifics – Road Show n Remove decisions l streamline by consistency – no “artists” n Reduce transitions or hand-offs n Challenge tradition n Dance the same dance l “Order Sheets”

7. Regional MI Alert The Core… n STEMI only n Definitive State-of-the-Art care n One call does it all n Parallel vs. sequential processing n Tight reporting of data for performance improvement

8. Faster is better

9. Reduction in Mortality! Overall Mortality: STEMI local and regional = 2.4%