EMS: An Integrated EMS: An Integrated Regional Systems Regional Systems Approach to Acute Approach to Acute

Events Events

STROKE , TRAUMA,STEMI STROKE , TRAUMA,STEMI

A FIVE MONTH REPORT A FIVE MONTH REPORT

SEAEMS SEAEMS

JANUARY – MAY 2015 JANUARY – MAY 2015

What is an integrated EMS What is an integrated EMS regional system ?regional system ?

IOM

•A coordinated, regionalized, accountable system.

STROKE STROKE 1/1/15 ---- 6/1/151/1/15 ---- 6/1/15

STROKE SYSTEM ENTRIES -STROKE SYSTEM ENTRIES -ADJUSTED 1/1/15 — 6/1/15ADJUSTED 1/1/15 — 6/1/15

STROKE TIME OF ONSET STROKE TIME OF ONSET (EMS ARRIVAL ) (EMS ARRIVAL ) 1/1/15-6/1/15 1/1/15-6/1/15

HOSPITAL REPORTS RECEIVED HOSPITAL REPORTS RECEIVED 1/1/15—6/1/151/1/15—6/1/15

HOSPITAL DIAGNOSIS HOSPITAL DIAGNOSIS 1/1/15– 6/1/151/1/15– 6/1/15

HOSPITAL ADMISSION HOSPITAL ADMISSION STATUS STATUS

TYPE OF STROKE TYPE OF STROKE 1/1/15--- 6/1/15 1/1/15--- 6/1/15

ALL ISCHEMIC TREATMENT ALL ISCHEMIC TREATMENT

HEMORRHAGICHEMORRHAGIC

• 2015 33.3% 2015 33.3%

• 2013 22.4% 2013 22.4%

• 20122012 19.2% 19.2%

• 20112011 16.9% 16.9%

• 20102010 15.9% 15.9%

• 20032003 10.1% 10.1%

• Why the climbing % of total strokes ? Why the climbing % of total strokes ?

STROKE HOSPITAL RED STROKE HOSPITAL RED TIMES 1/15-5/15TIMES 1/15-5/15

CHALLENGES CHALLENGES /OPPORTUNITES /OPPORTUNITES

• STROKE SYSTEM PATIENTS DIRECTLY STROKE SYSTEM PATIENTS DIRECTLY TO SCANNER -- WHY NOT ?????? TO SCANNER -- WHY NOT ??????

CT PERFORMED CT PERFORMED

ADDITIONAL CHALLENGES ADDITIONAL CHALLENGES

• EMS Transfer Drug Course inclusion EMS Transfer Drug Course inclusion of LYTIC for stroke (BP CONTROL- of LYTIC for stroke (BP CONTROL- ANAPHYLAXIS (EDEMA) Referring ANAPHYLAXIS (EDEMA) Referring orders or ?, Lytic complete or still orders or ?, Lytic complete or still running, other concerns)running, other concerns)

• ATRIAL FIB. As a data point & ATRIAL FIB. As a data point & measured /reported measured /reported

• Hospital entries via email or text Hospital entries via email or text

TRAUMA 1/1/15--- 5/31/15 TRAUMA 1/1/15--- 5/31/15

PATIENT DESTINATIONS PATIENT DESTINATIONS 1/15- 5/151/15- 5/15

ATS ENTRY COMPARISONATS ENTRY COMPARISON

EMSP-DISCRETION EMSP-DISCRETION ENTRY METHOD ENTRY METHOD

EMSP-DISCRETION ADMITS EMSP-DISCRETION ADMITS

ALL ENTRIES ADMIT STATUS ALL ENTRIES ADMIT STATUS

( over-triage ) ( over-triage )

REGIONAL ADMITS/NON REGIONAL ADMITS/NON ADMITS MISSING HOSPITAL ADMITS MISSING HOSPITAL RECORDS 1/15– 5/15RECORDS 1/15– 5/15

TRAUMA HOSPITAL RED TRAUMA HOSPITAL RED 1/15—5/151/15—5/15

STEMI SYSTEM PATIENTS STEMI SYSTEM PATIENTS 1/1/15—5/31/15 1/1/15—5/31/15

• 233 PATIENT ENTRIES 233 PATIENT ENTRIES

• 86 EMERGENTLY SENT TO THE Cath 86 EMERGENTLY SENT TO THE Cath Table Table

• 16 16 NOT NOT ADMITTED (93%) ADMITTED (93%)

QUESTIONS ?????QUESTIONS ?????

WHAT CAN WE DO TO WHAT CAN WE DO TO IMPROVE ATCC ?IMPROVE ATCC ?