2. National AMI Information Call February 5, 2008 Patient Safety Initiative

3. Elements of AMI bundle Early administration of aspirin Aspirin at discharge Beta-blocker at discharge ACE-inhibitor or angiotensin receptor blocker at discharge

4. Elements of AMI bundle Timely reperfusion (thrombolysis or percutaneous intervention) Smoking cessation counseling

5. Today’s focus: Issues and opportunities related to capturing and improving the timing of AMI care at the receiving hospital and the tertiary PCI centre

6. Southlake Regional Health Centre 323 bed hospital in Newmarket, Ontario Regional Cardiac Care Program Advanced services: Interventional Cardiology, Cardiac Surgery and Heart Rhythm Programs

7. Successful strategies to improve AMI and timely PCI Early repatriation of PCI patients back to referring hospitals Increased availability of cath lab and interventional team (expanded working hours) Regional PCI guidelines developed and disseminated to regional partners Primary PCI implemented within SRHC

8. Successful strategies to improve AMI and timely PCI Implementation of regional STEMI bypass program Dedicated data analyst for PCI data Ongoing collaboration with our own ER department and with regional partners

9. Challenges Number of advanced vs. primary paramedics in region Cost of equipment: technology to transmit ECG’s from ambulance Cath lab in use Bed availability and patient flow Efficient use of PCI unit

10. AMI

11. The Credit Valley Perspective Credit Valley Hospital is a 383 bed community hospital 360 patients admitted with acute myocardial infarction (AMI) in 2006/2007

12. AMI Data 139 subendocardial myocardial infarctions admitted 113 admitted to CCU 102 transferred to other facility for coronary intervention

13. In the Beginning… EFFECT study (1999-2004) Retrospective chart review of AMI patients 135 charts audited Quality indicators included risk factor reduction, ‘door to needle time’, aggregate secondary prevention (ICES/CCORT, 2004)

14. EFFECT Study Current practice in the ER is to use pre- printed physician orders and the A.C.T. team for all AMI patients

15. PCI or TnK?? No percutaneous coronary intervention facility on site at Credit Valley Hospital for primary PCI Treatment delays a risk when transferring to other facility for primary PCI Pharmacotherapy the best choice for STEMI patients Facilitated PCI (TRANSFER-AMI)

16. STEMI Data 2007 (Jan to June) SHN goal 85% of patients with door to needle time < 30 min Average time for January 2007 to June 2007 was 37.4 minutes (median 28.5) 54% of CVH patients had door to needle time < 30 min

17. Challenges… Time to ECG Changing cardiac patient population Transportation issues

18. Opportunities Regionalized care for AMI patients requiring interventions Improved transfer protocols with an organized, patient centered focus Enhanced communication and documentation

19. Questions? Thank you for your interest in SHN! Amanda Darwood RN BSc, Southlake Regional Health Centre Rachel French RN, Credit Valley Hospital