Utilizing data to improve STEMI patient care
The journey to Mission: Lifeline recognition for Paramedics Plus improved the STEMI system of care through better data capture, communication and trust
By Marc S. McSherry
Patients suffering from STEMI heart attacks, usually associated with a recently closed coronary artery, are more likely to survive if their coronary artery is opened within 12 hours of onset. This requires EMS personnel to recognize the signs of STEMI heart attacks, and take quick action. However, timely treatment doesn’t fall solely on the EMS crews. Collaboration and trust with STEMI receiving centers and local hospitals are vital to positive patient outcomes.
Paramedics Plus, the 911 ambulance transport service for the city of Sioux Falls, S.D., earned the American Heart Association’s Mission: Lifeline EMS Bronze Level Recognition Award in 2016. Through this award, the American Heart Association recognizes the effort by prehospital and hospital providers to work together to improve systems of care for STEMI patients.
The award application process can be daunting, and many EMS agencies are overwhelmed by the data required to apply. The full value of applying for the award goes beyond receiving it.
The data exists; the problem is compiling it
Most, if not all, EMS agencies already have the data needed to apply for Mission: Lifeline recognition. Standard patient care reports contain the number of STEMI patients who were transported and the number of those who received a 12-lead ECG.
It’s simply a matter of compiling the necessary data. Paramedics Plus started the process two years prior to earning the award because of the volume of data needed for the application. It embraced the access to a wide array of data, and used certain metrics to measure and improve patient care for STEMI patients.
Prehospital and follow-up data from hospitals are required to apply for the Mission: Lifeline EMS Recognition Award. EMS agencies have several key data points to collect internally:
- Number of patients (35 years old or above) with non-traumatic chest pain who were transported, and the number of those who received a 12-lead ECG.
- Time of first medical contact on STEMI patients (18 years old and above).
The next step is gathering follow-up data from the hospitals where STEMI patients were transported, including:
- Time of fibrinolytic administration for patients transported to a STEMI referring center.
- Time of device activation/primary percutaneous coronary intervention for patients transported to a STEMI receiving center.
The application requires a calendar year of data. Paramedics Plus found that compiling this large amount of data is much more doable on a weekly, monthly and quarterly basis.
Overall system support also makes collecting data from several different entities much easier. In Sioux Falls, Paramedics Plus found this support in the Sioux Falls Regional Emergency Medical Services Authority. Paramedics Plus alerted REMSA that it wanted to pursue the award and REMSA facilitated discussions with the entities involved in Sioux Falls’ STEMI systems of care, including Sioux Falls Fire Rescue and local hospitals.
Sharing data improves relationships
There are three hospitals in Sioux Falls and Paramedics Plus is the only EMS provider. While Paramedics Plus already had good working relationships with local hospitals, the application process encouraged additional and more detailed conversations about patient care. For example, Paramedics Plus and the local hospitals discussed the assessments that EMTs and paramedics use in the field to identify who is experiencing a STEMI heart attack.
Paramedics Plus’ Lifepak 15 cardiac monitors allow crews to transmit the 12-lead ECG report to give a vital early warning to the hospital and communicate patient information, which helps securing a place and team for the patient in the cath lab. And while hospitals rely on this early notification from Paramedics Plus to make space, they previously had to reaffirm the STEMI alert in the emergency department before taking the patient to the cath lab, which would cost patients valuable time.
Through the discussions, the hospitals gained a level of comfort with Paramedics Plus’ ability to correctly identify STEMI, which led to patients being able to bypass the emergency department and go straight to the cath lab.
Date improves communications
Paramedics Plus’ collaboration with the hospitals, REMSA and the local American Heart Association chapter helped each organization to share its knowledge and ideas on how to better provide care to STEMI patients. Those who are involved in STEMI care – Paramedics Plus, Metro Communications, cardiologists, hospital administration, and hospital nursing, emergency department and cath lab team members – formed chest pain care committees that meet quarterly.
These quarterly meetings provide a feedback loop for the STEMI systems of care as a whole. Patient cases are discussed, which allows first responders to learn outcomes of the patients who they treated, and determine if any improvements could have been made during the system of care.
More than an award
The Mission: Lifeline award is a great honor and achievement, but the award itself was a small piece in the overall benefits. It increased communications and trust, which has drastically improved the STEMI system of care in Sioux Falls. In turn, it improved the outcomes for patient in this community.
About the author
Marc S. McSherry, MD, FACEP is the medical director for Paramedics Plus in Sioux Falls and Sanford University of South Dakota Emergency Department. He is also an emergency department physician at Sanford USD Medical. Dr. McSherry has more than 20 years of experience in EMS including working as a paramedic, flight physician and medical director. He is a Fellow of American College of Emergency Physicians.