Your SlideShare is downloading. ×
0
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
STEMI Regulations Part 2
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

STEMI Regulations Part 2

625

Published on

Dr. Samar Muzaffar provides an update on the STEMI regulations, policies and procedures, as they impact rural health care providers.

Dr. Samar Muzaffar provides an update on the STEMI regulations, policies and procedures, as they impact rural health care providers.

Published in: Education
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
625
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
0
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide
  • Welcome—Local person can begin—welcome group.
    Introductions
  • Identify those that are from the region
    Explain that the colors reflect the colors that are in each of the 6 respective regions.
    Meeting Schedule
    Jefferson City September 29Central
    KirksvilleOctober 5Central
    Cape GiradeauSeptember 30Southeast
    St. LouisOctober 1East Central
    Kansas CityOctober 6Kansas City and Northwest
    SpringfieldOctober 7Southwest
  • The End Goal is this:
    An integrated emergency medical care system that broadens the trauma system approach and perspective to improve injury prevention efforts, patient care throughout this circle, and ultimately, to improve patient outcomes across the state of Missouri.
  • Stroke, STEMI and trauma are all time critical diagnoses.
    Tag line reference- Right Care at the Right Place at the Right Time
    Table of contents
  • The magnitude of the time critical diagnoses clearly warrant attention
    The FACT SHEET in your packets also outlines some other noteworthy facts about these conditions.
  • Luckily, we have an existing model – the Trauma model saves lives by making sure that patients in need of acute trauma care get to the right facility as quickly as possible.
    And it’s a proven model. The trauma system saves lives, improves patient outcomes, creates efficiencies and cost savings, and allows for regional and local variations.
  • Need to update
  • Transition to DHSS staff
  • Fall meetings are at the tail-end of the drafting process. Have had over 20 statewide meetings/conference calls and now conducting meetings to provide overview to interested health care community.
    We need your feedback. Welcome your input at this stage.
  • These Regulations to be written
  • - The designation process will identify hospital’s levels within stroke and STEMI. The requirements for designation have been developed by the TCD team and will be approved as part of the regulations.
    EMS and hospital personnel will all be included in the professional education program.
    A public education plan will be developed in 2010 – will likely include media outreach and speaking engagements.
  • The End Goal is this:
    An integrated emergency medical care system that broadens the trauma system approach and perspective to improve injury prevention efforts, patient care throughout this circle, and ultimately, to improve patient outcomes across the state of Missouri.
  • The End Goal is this:
    An integrated emergency medical care system that broadens the trauma system approach and perspective to improve injury prevention efforts, patient care throughout this circle, and ultimately, to improve patient outcomes across the state of Missouri.
  • Transcript

    • 1. Right Care. Right Place. Right Time. The Role of the Rural and Critical Access Hospital in the TCD System
    • 2. Right Care. Right Place. Right Time.
    • 3. Right Care. Right Place. Right Time. The End Goal: 360/365 Emergency Medical Care System
    • 4. Right Care. Right Place. Right Time. Meeting Purpose • TCD System Review – Background – Overview of Proposed Missouri Regulations • Rural Hospital and CAH Roles in the TCD System • Next Steps • Questions
    • 5. Right Care. Right Place. Right Time. TCDS Background and History
    • 6. Right Care. Right Place. Right Time. Why Time Critical Diagnosis System Matters: Leading causes of death in Missouri 1st Heart Disease, including ST-Elevation Myocardial Infarction (STEMI) 3rd Stroke 1st /4th /5th Trauma-injury-accidents, motor vehicle accidents, suicide, homicide, other; Leading cause of YPLL
    • 7. Right Care. Right Place. Right Time. Why Time Critical Diagnosis Matters: STEMI • Heart disease, including STEMI, is the leading cause death in this state. • In 2004, Missouri’s heart disease death rate was 13.5 percent higher than the national rate. • Missouri was in the bottom ten (45 out of 52) in coronary heart disease death rates. • The prevalence of heart disease was higher than the national average – Missouri ranked 9th among the 50 states in heart disease prevalence in 2005. • . Rosamond, W, Flegal K, Furie, K, et.al. Heart Disease and Stroke 2008 Update: A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2008; 117; e25-el46; Epub 2007 December 17; http://circahajournals.org/cgi/content/full/117/4/e25. Retrieved June 24, 2008. • . MO BRFSS 2005
    • 8. Right Care. Right Place. Right Time. Why Time Critical Diagnosis Matters: STEMI STEMI • Shorter time from door-to-balloon (PCI) - lower risk of mortality – Moving towards first medical contact to balloon • Symptom onset to treatment time greater than 4 hours independent predictor of one-year mortality • Faster treatment and lower in-hospital mortality associated with hospital “specialization” and emphasis on PCI as principal mode of reperfusion Prompt treatment reduces death and disability.
    • 9. Right Care. Right Place. Right Time. Why Time Critical Diagnosis Matters: Stroke STROKE • Stroke is the third leading cause of death in the state. • In 2004, Missouri’s stroke death rate was 11 percent higher than the national rate. • Missouri ranked low (40 out of 52) in the comparison of stroke death rate between states. • Missouri was ranked 7th in stroke prevalence. • 15-30% will be disabled (leading cause of disability) • 20% require institutionalization first 3 months post-stroke • Only a small percent of ischemic stroke patients get definitive care within the 3 hour window recommended. Prompt treatment reduces death and disability.
    • 10. Right Care. Right Place. Right Time. Why Time Critical Diagnosis Matters: Stroke STROKE • t-PA Treatment within 180 minutes from symptom onset: - Better odds of improvement at 24 hours - Improved 3-month outcome • Patients treated after 180 minutes - Poorer outcomes - More hemorrhages Prompt treatment reduces death and disability.
    • 11. Right Care. Right Place. Right Time. Why Time Critical Diagnosis Matters: Trauma TRAUMA • Trauma is the first, fourth or fifth leading cause of death in Missouri depending on group • It is the most frequent cause of visits to the emergency department, causing more than half a million visits in 2006 • Missouri death rates for unintentional injuries increased 25% between 1991 and 2006 • Missouri death rates for accidental injuries, suicides, falls and MVC’s exceed national rates • There are gaps, particularly in rural areas, for timely access to trauma care Prompt treatment reduces death and disability.
    • 12. Right Care. Right Place. Right Time. Using Trauma System as a Model Trauma System: • Improves Patient Outcomes and Saves Lives - 50% reduction in preventable death rate after implementation - Decrease in cases of sub-optimal care from 32% to 3% • Improves Hospital Outcomes - Better outcomes compared to voluntary system - Cost Savings through more efficient use of resources • Improves Regional Outcomes - Regional system accommodates regional and local variations
    • 13. Right Care. Right Place. Right Time. Missouri’s Goals –Reduce incidence and severity of injury, stroke, and STEMI –Improve access into the system –Improve outcomes of those injured or suffering stroke and STEMI –Improve system evaluation and QA/QI/PI Processes
    • 14. Right Care. Right Place. Right Time. Missouri’s Key Guiding Principles –Patient centered care –Evidence-based system design –Population-based approach –Evaluation mechanism
    • 15. Right Care. Right Place. Right Time. TCD System Goal Prompt treatment reduces death and disability.
    • 16. Right Care. Right Place. Right Time. Developing the System: August 2008: TCD Stroke/STEMI Task Force compiled formal recommendations Sept.’08-Present: TCD Trauma Task Force convened for compiling recommendations 2008-Present: Stroke and STEMI Implementation groups meeting regularly and compiling standards for stroke and STEMI center designation and EMS Implementation: Progress and Goals
    • 17. Right Care. Right Place. Right Time. Overview of Regulations
    • 18. Right Care. Right Place. Right Time. Legislative Synopsis: 2008: House Bill 1790 enabling reform passed unanimously by the Missouri Assembly and signed into law RSMo 190-100 Definitions RSMo 190.200 Public Information & Education RSMo 190.241 Center Designation RSMo 190.243 Transportation to Centers Implementation: Progress and Goals
    • 19. Right Care. Right Place. Right Time. Missouri Regulations 1. Law authorizes DHSS to promulgate regulations 2. Inclusive process for drafting regulations 3. DHSS submits as “Proposed Rules” – Office of the Secretary of State and – Joint Committee on Administrative Rules 1. Public Comment Period 2. Final Rules
    • 20. Right Care. Right Place. Right Time. Missouri Regulations Both Stroke & STEMI Four Levels of Center Designation Level I Functions as resource center within region Level II Provide care to high volumes of stroke and STEMI patients Level III Access into system in non-metropolitan areas, more limited resources and generally refer to higher level center Level IV Access in rural areas, stabilize and prepare for rapid transfer to higher level of care
    • 21. Right Care. Right Place. Right Time. Missouri Regulations Both Stroke & STEMI • Voluntary process • Stroke/STEMI Program-24/7 (all levels) – Medical Director – Program Manager/Coordinator • Staff meet and maintain core requirements to provide care • One-call activation protocol • Transfer – network agreements
    • 22. Right Care. Right Place. Right Time. Missouri Regulations Both Stroke & STEMI • Data submission for statewide registry • Performance improvement and patient safety requirements • Public education to promote prevention and signs and symptoms awareness
    • 23. Right Care. Right Place. Right Time. Missouri Regulations STEMI Center Stipulations Level I Level II PCI Receiving Center PCI Receiving Center
    • 24. Right Care. Right Place. Right Time. Missouri Regulations STEMI Center Stipulations Level III Level IV Lytic Center some PCI capability “Drip and Ship”
    • 25. Right Care. Right Place. Right Time. Missouri Regulations CMEs-STEMI Level I Level II Level III Level IV Medical Director- 10 hrs/yr 10 hrs/yr 8 hrs/every other yr Call Roster 10 hrs/yr 10 hrs/yr 8 hrs/every other yr ED Doctor 4 hrs/yr 6 hrs/every other yr
    • 26. Right Care. Right Place. Right Time. Missouri Regulations Continuing Education-STEMI Level I Level II Level III Level IV Manager 10 hrs/yr 8 hrs/yr 8 hrs every other yr. ED RN 4 hrs/yr 4 hrs/yr 6 hrs every other year ICU RN 8 hrs/yr Not required STEMI Unit RN 8 hrs/yr (I, II) and 8 hrs/every other year (III) Not required
    • 27. Right Care. Right Place. Right Time. Missouri Regulations Stroke Center Stipulations Level I Level II Align with comprehensive stroke center standards •Align with The Joint Commission-Primary Stroke Centers standards
    • 28. Right Care. Right Place. Right Time. Missouri Regulations Stroke Center Stipulations Level III Level IV “Drip and Ship” Rapid Entry into the System
    • 29. Right Care. Right Place. Right Time. Missouri Regulations CMEs-Stroke Level I Level II Level III Level IV Medical Director- 12 hrs/yr 8 hrs/yr 8 hrs every other yr. And 6 hrs every other yr. Call Roster 10 hrs/yr 8 hrs/yr ED Doctor 4 hrs/yr 4 hrs/yr
    • 30. Right Care. Right Place. Right Time. Missouri Regulations Continuing Education-Stroke Level I Level II Level III Level IV Manager 10 hrs/yr 8 hrs/yr 8 hrs every other yr. and 6 hrs every other yrED RN 4 hrs/yr 4 hrs/yr ICU RN 10 hrs/yr 8 hrs/yr Not required Stroke Unit RN 10 hrs/yr 8 hrs/yr Not required (8 hrs for III’s that will keep pts. under supervised relationship with a II or II)
    • 31. Right Care. Right Place. Right Time. Missouri Regulations Trauma • Level IV Trauma Center regulations under development •Survey sent to CAH • Update old trauma regulations • Update pediatric trauma regulations • Transport under discussion • Injury Specific triage/transfer guidelines under development • Other
    • 32. Right Care. Right Place. Right Time. Missouri Regulations STEMI and Stroke Patient Transport • STEMI patient classification • STEMI patient transport • Stroke patient classification • Stroke Patient Transport
    • 33. Right Care. Right Place. Right Time. Missouri Regulations Regional Plans Regional or community based plans for transporting trauma, STEMI or stroke patients may be submitted to DHSS. 190.200 RSMo but not required
    • 34. Right Care. Right Place. Right Time. Rural and CAH’s in the TCD System
    • 35. Right Care. Right Place. Right Time. Rural and CAH’s • Stroke Regulation Review • STEMI Regulation Review • We will develop guidelines for Rural and Critical Access Hospitals and receiving hospitals
    • 36. Right Care. Right Place. Right Time. Next Steps
    • 37. Right Care. Right Place. Right Time. 1. Work group compiling plan and materials 2. Launch public education campaign – TCD System/9-1-1 – Signs and symptoms and importance of calling 911 Next Steps Public Education
    • 38. Right Care. Right Place. Right Time. 1. Professional education planning (Fall-2009 through Summer-2010) 2. Convene Professional Education work group (Fall 2010) 3. Conduct professional education (Begin mid- 2011) Next Steps Professional Education
    • 39. Right Care. Right Place. Right Time. Next Steps Tracking Progress Create evaluation mechanism to track progress and outcomes
    • 40. Right Care. Right Place. Right Time. 1. Review existing data system – CDC Info Aid – MU Health Informatics 1. Convene quality assurance work group (late 2010) – Define data points (benchmarks, PI, indicators, outcomes) – Review existing systems for collection – Compile plan to populate state Stroke and STEMI registry without creating burden for reporters 1. Implement plan – Update state database and reporting methodologies – Training – Compile reports to support PI/Quality Assurance – Regional Processes Next Steps Quality Assurance
    • 41. Right Care. Right Place. Right Time. 1. DHSS creates application—filed as part of regulations 2. Once regulations effective, hospitals may submit application (similar to trauma center application and review process currently in place) 3. DHSS conducts review 4. DHSS approves designation for those that meet standards Next Steps Center Application
    • 42. Right Care. Right Place. Right Time. The End Goal: 360/365 Emergency Medical Care System
    • 43. Right Care. Right Place. Right Time. The End Goal:
    • 44. Right Care. Right Place. Right Time. Contact Information • Dr. Samar Muzaffar – samar.muzaffar@dhss.mo.gov • Cindy Gillam – cindy.gillam@dhss.mo.gov • Website – www.dhss.mo.gov; go to Time Critical Diagnosis System

    ×