Healthcare reform goals of improved quality and reduced cost are causing many hospitals to reach across boundaries and work with competing hospitals to coordinate care. Charlotte, N.C.-based Carolinas HealthCare System collaborates with competitors and independent hospitals through the Regional Approach to Cardiovascular Emergencies project, a statewide initiative to treat heart attack patients as quickly as possible.
RACE connects emergency medical services and hospitals in the region to develop standardized protocols for treating patients with ST-segment elevation myocardial infarction. The American Heart Association's Mission: Lifeline STEMI program, which aims to create STEMI systems of care to improve treatment for heart attack patients, has embraced and endorsed the RACE guidelines
Racing to improve care
A regionalized approach to heart attack care can speed and enhance the quality of care. For example, in conjunction with the RACE program, CHS has reduced the time from a patient's hospital arrival to treatment from 109.5 minutes in 2007 to 88 minutes in 2011 for its nine-hospital network. The regional approach has also increased the percentage of treatment times under 90 minutes from 22.8 percent to 55.4 percent. The success of the RACE program has led to an initiative to expand the model to other states. So far, the American Heart Association's Mission: Lifeline STEMI Systems Accelerator program established STEMI systems in 20 regions across the country.
Lee Garvey, MD, director of emergency cardiac care at CHS' Carolinas Medical Center in Charlotte, and Hadley Wilson, MD, chief of adult cardiology at CHS' Sanger Heart & Vascular Institute, discuss three key elements of regionalized heart attack care that drive its success.
1. Teamwork. The foundation of a regional STEMI system is the hospital-based teams of healthcare providers who coordinate heart attack care across a region. Team members include emergency physicians and nurses, emergency medical services staff, cardiologists, cardiac surgeons, radiologists and more.
To coordinate care across hospitals, team members need to communicate clearly and often. For example, a hospitalthat is transferring a patient to another hospital needs to clearly communicate the situation so the receiving hospital can be prepared to treat the patient quickly and effectively. "It takes teamwork — champions from [different] disciplines to work with the goal of improving every patient's care — not just patients that come to my hospital or my system, but all heart patients across a region," Dr. Garvey says.
2. Standardized protocols. Regionalized STEMI systems also derive success from standardized protocols that all team members throughout the region agree on. "When things are standardized, it's easier to eliminate variation; when you eliminate variation, it leads to more consistent care," Dr. Garvey says.
For example, hospitals in the RACE program developed protocols for treating STEMI patients within a hospital and for transferring patients between hospitals. These protocols ensure providers are following evidence-based guidelines to produce the best clinical outcomes and generate cost savings through greater efficiency and the avoidance of complications.
"It's not only saving lives, but if you get people with heart attacks treated quicker, you reduce the amount of heart damage; you reduce the amount of patients who subsequently have weakened hearts, heart failure and other problems that require defibrillators, pacemakers and other types of long-term care," Dr. Wilson says.
3. Feedback via data. Hospitals in the RACE project improved quality and efficiency by continually collecting, assessing and acting on data. Since time is critical for heart attack patients, there are many data points relating to timing. CHS collects data on the time from EMS' first contact with the patient to the emergency department; the time from a patient's arrival to receiving percutaneous coronary intervention; and the time for a patient to be transferred between hospitals, among other time metrics.
For the data to be useful, every member of the heart attack care team has to have access to the data. At CHS, data is abstracted from patients' charts within 24 to 48 hours of presentation and becomes available to all team members electronically. In addition, each hospital's team meets regularly to discuss the data and strategize ways to improve.
An example of how data assessment led to improvement is a referral hospital's time to admit a heart attack patient. Hospital leaders identified a slightly longer time between a patient's arrival and admission to the hospital. After discussing this issue with the hospital, leaders determined that there was a slight change in chest pain staffing. By reeducating staff and redistributing protocols, the hospital was able to speed its admission process, according to Dr. Garvey.
Continuous improvement
CHS emphasizes the importance of data because it forms the basis of continuous improvement projects. "The data feedback is critical to understanding what the processes are, where we're being most successful and where opportunities are for further improvement," Dr. Garvey says. "The focus is trying to identify ways to make a very good system even better."
For example, CHS has set internal goals beyond national guidelines to continue to reach for better outcomes. CHS aims to treat patients within 60 minutes of arrival at the hospital instead of the national standard of 90 minutes, according to Dr. Wilson. By keeping abreast of process and outcome data, regionalized systems can continue to raise the bar for treating STEMI patients.
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RACE connects emergency medical services and hospitals in the region to develop standardized protocols for treating patients with ST-segment elevation myocardial infarction. The American Heart Association's Mission: Lifeline STEMI program, which aims to create STEMI systems of care to improve treatment for heart attack patients, has embraced and endorsed the RACE guidelines
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| Dr. Lee Garvey |
A regionalized approach to heart attack care can speed and enhance the quality of care. For example, in conjunction with the RACE program, CHS has reduced the time from a patient's hospital arrival to treatment from 109.5 minutes in 2007 to 88 minutes in 2011 for its nine-hospital network. The regional approach has also increased the percentage of treatment times under 90 minutes from 22.8 percent to 55.4 percent. The success of the RACE program has led to an initiative to expand the model to other states. So far, the American Heart Association's Mission: Lifeline STEMI Systems Accelerator program established STEMI systems in 20 regions across the country.
Lee Garvey, MD, director of emergency cardiac care at CHS' Carolinas Medical Center in Charlotte, and Hadley Wilson, MD, chief of adult cardiology at CHS' Sanger Heart & Vascular Institute, discuss three key elements of regionalized heart attack care that drive its success.
1. Teamwork. The foundation of a regional STEMI system is the hospital-based teams of healthcare providers who coordinate heart attack care across a region. Team members include emergency physicians and nurses, emergency medical services staff, cardiologists, cardiac surgeons, radiologists and more.
 |
| Dr. Hadley Wilson |
To coordinate care across hospitals, team members need to communicate clearly and often. For example, a hospitalthat is transferring a patient to another hospital needs to clearly communicate the situation so the receiving hospital can be prepared to treat the patient quickly and effectively. "It takes teamwork — champions from [different] disciplines to work with the goal of improving every patient's care — not just patients that come to my hospital or my system, but all heart patients across a region," Dr. Garvey says.
2. Standardized protocols. Regionalized STEMI systems also derive success from standardized protocols that all team members throughout the region agree on. "When things are standardized, it's easier to eliminate variation; when you eliminate variation, it leads to more consistent care," Dr. Garvey says.
For example, hospitals in the RACE program developed protocols for treating STEMI patients within a hospital and for transferring patients between hospitals. These protocols ensure providers are following evidence-based guidelines to produce the best clinical outcomes and generate cost savings through greater efficiency and the avoidance of complications.
"It's not only saving lives, but if you get people with heart attacks treated quicker, you reduce the amount of heart damage; you reduce the amount of patients who subsequently have weakened hearts, heart failure and other problems that require defibrillators, pacemakers and other types of long-term care," Dr. Wilson says.
3. Feedback via data. Hospitals in the RACE project improved quality and efficiency by continually collecting, assessing and acting on data. Since time is critical for heart attack patients, there are many data points relating to timing. CHS collects data on the time from EMS' first contact with the patient to the emergency department; the time from a patient's arrival to receiving percutaneous coronary intervention; and the time for a patient to be transferred between hospitals, among other time metrics.
For the data to be useful, every member of the heart attack care team has to have access to the data. At CHS, data is abstracted from patients' charts within 24 to 48 hours of presentation and becomes available to all team members electronically. In addition, each hospital's team meets regularly to discuss the data and strategize ways to improve.
An example of how data assessment led to improvement is a referral hospital's time to admit a heart attack patient. Hospital leaders identified a slightly longer time between a patient's arrival and admission to the hospital. After discussing this issue with the hospital, leaders determined that there was a slight change in chest pain staffing. By reeducating staff and redistributing protocols, the hospital was able to speed its admission process, according to Dr. Garvey.
Continuous improvement
CHS emphasizes the importance of data because it forms the basis of continuous improvement projects. "The data feedback is critical to understanding what the processes are, where we're being most successful and where opportunities are for further improvement," Dr. Garvey says. "The focus is trying to identify ways to make a very good system even better."
For example, CHS has set internal goals beyond national guidelines to continue to reach for better outcomes. CHS aims to treat patients within 60 minutes of arrival at the hospital instead of the national standard of 90 minutes, according to Dr. Wilson. By keeping abreast of process and outcome data, regionalized systems can continue to raise the bar for treating STEMI patients.
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