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STEMI Care in Everett

In October 2009, Dr. Budge Smith presented on the advancements in STEMI care at PRMCE in Everett, Washington. Key initiatives included staff education, EMS outreach, and improved EKG interpretation to facilitate swift patient transfer. A streamlined process from field information transmission to direct cath lab activation was emphasized. Strategies implemented aimed to reduce door-to-EKG time to under ten minutes, prioritize patient care, and effectively utilize resources during critical situations. Ongoing quality data analysis and risk-adjusted outcomes were highlighted to maintain high standards of care for STEMI patients.

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STEMI Care in Everett

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  1. Budge Smith, MD, FACC Cath Lab Medical Director, PRMCE Western Washington Medical Group Cardiology Everett, Washington October 2009 STEMI Care in Everett

  2. From the Community to the ED • Ongoing education effort to public and clinical staff • EMS Outreach program • EKG interpretation • Rapid transfer of field information to ED, including electronic transmission • Direct activation of cath lab by verbal report from the field • Potential expense with regard to false positives

  3. In the Emergency Department • Limit door to EKG time to <10 minutes • If triage is full, move prioritized patient to gurney and perform EKG in hallway • Activate senior nursing staff • Designated STEMI nurse on each shift • Produce and use STEMI cart • Limit extraneous activities • Limit labs to I-stat labs, creatinine, hgb • No CXR unless indicated

  4. Use of Reperfusion Therapy for STEMI Patients July, 2008 – June, 2009

  5. Pre-Procedural Considerations • CVL staff to ED to transport and receive report • 4 staff on call • Cross training is important so room set up occurs while patient is being transported • IV and groin pre done by all staff • Physicians help set up, transfer, and drape patient when applicable • Do not wait on dictation • Do not wait for consent • Life threatening situation • Patient has received sedation • Family may not be available

  6. Pre-Procedural Timing (minutes)

  7. In CVL • Dedicated information system to be able to record accurately • Interface between hemodynamic and information system • Physician notes time of dilation for accuracy and consistency • Close the feedback loop with system-generated patient report

  8. Procedural Timing (minutes)

  9. Door to Dilation Time Trends NRMI data  ACTION Data

  10. Door to Dilation Time Trends NRMI data  ACTION Data

  11. Median Length of Stay

  12. Unadjusted In-Hospital Outcomes for STEMI • Risk Adjusted Mortality • Providence = 4.0% • Nation = 6.3% • Top 10% = 5.4% Outcome (%) * Bleeding censored at time of CABG

  13. Risk Adjusted Mortality* NRMI data  ACTION Data * Risk Models have changed over time

  14. The shape of things to come… • 360 new beds • Opening Fall 2011

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