6 Steps to Achieve Heart Attack Referring/Receiving Center Accreditation
In March, St. Luke's Episcopal Hospital in Houston became one of ten hospitals awarded accreditation as a Mission: Lifeline Heart Attack Referring/Receiving Center by the American Heart Association and the Society of Chest Pain Centers. These two organizations partnered to create the accreditation program in September 2011 to recognize hospitals that quickly and appropriately treat heart attack patients. Larry Brown, RN, coordinator of the St. Luke's Episcopal Hospital's ST-segment elevation myocardial infarction program, provides six steps hospitals can follow to become an accredited Heart Attack Referring/Receiving Center.
1. Register with "Get With the Guidelines." Get With the Guidelines is an American Heart Association program that requires hospitals to record certain quality metrics in heart care. Data is collected on patients who come through the emergency department or are brought in by emergency medical services. Hospitals have to meet standards of care for these metrics at least 75 percent of the time with an overall compliance rate of 85 percent. Hospitals that achieve this goal for at least one quarter receive a bronze award, while hospitals who meet guidelines for a year receive a silver award and those that meet standards for two consecutive years receive a gold award. Eligibility for Heart Attack Referring/Receiving Center accreditation requires hospitals reach at least the bronze level.
2. Monitor data closely. Get With the Guidelines has nearly 300 detailed data points covering a range of measures, such as the door (or emergency medical services)-to-balloon time — the time of first contact with the patient to when he or she receives treatment. The D2B and E2B time should be within 90 minutes.
One of the greatest challenges of achieving Get With the Guidelines awards — and thus becoming eligible for the Mission: Lifeline accreditation — is monitoring statistics for every STEMI patient every day, according to Mr. Brown. "You have to pay attention to the small stuff. You can't just look at the big picture and think you're going to make it. You have to constantly look at individual parameters right along the continuum of care. Identify every one and make sure that you're meeting that parameter every time. It's the only way to make sure [you meet requirements]," he says.
For example, he says if a hospital has only four STEMI patients in one month and it exceeds the D2B time for one patient, the hospital is already down to 75 percent for that measure. If a hospital does not meet a standard it should look at its data to identify gaps in care and opportunities to improve. "Watching performance every day is key to making continual progress and maintaining that level of service," Mr. Brown says.
3. Focus on E2B times. One of the most challenging requirements for hospitals, and the one that often prevents them from reaching a Get With the Guidelines award, is the E2B time, according to Mr. Brown. Achieving an E2B time under 90 minutes requires continual cath lab coverage and responsive staff. If a patient arrives at the ED after hours and the hospital does not have a cardiologist on hand, the cardiologist will have to be called in, which adds time. "Unless you have a good after-hours rapid response team to transfer STEMI patients to the cath lab, you're going to have a problem," Mr. Brown says. As a large teaching hospital, St. Luke's Episcopal has two or three cardiology fellows on-site all the time to facilitate transfer of STEMI patients to the cath lab. This enables the hospital to consistently reach E2B time requirements.
4. Apply for Accreditation. If hospitals are vigilant in tracking data and achieve at least a bronze award, they can apply for Heart Attack Referring/Receiving Center accreditation. The accreditation program "raises the bar" on requirements, such as physician credentialing and patient volume requirements, according to Mr. Brown. As part of the accreditation process, a surveyor evaluates the center in person to determine whether the hospital is up to par.
5. Build a relationship with EMS. One of the requirements for the Heart Attack Referring/Receiving Center accreditation is maintaining a strong relationship with EMS. St. Luke's Episcopal Hospital consistently recognizes EMS's contribution to the rapid treatment of STEMI patients as well as provides opportunities for education and feedback. EMS notifies St. Luke's Episcopal before a STEMI patient comes in. "We empower them to make the diagnosis and activate the STEMI team prior to arrival," Mr. Brown says.
Upon arrival, a cardiologist meets EMS at the door to receive information about the patient and communicate directly with the paramedics, who transport the patient to the cath lab on the EMS stretcher. Typically the paramedics stay in the catheterization lab with the patient throughout the procedure. This practice provides paramedics with first-hand knowledge to correlate clinical presentation, ECG findings and definitive angiographic findings.
In addition, Mr. Brown conducts a formal case follow-up that details the E2B time and the patient's history, diagnosis and outcome. These reports give EMS an opportunity to learn and improve.
6. Establish ongoing education programs. Accredited Heart Attack Referring/Receiving Centers are required to have ongoing education programs on heart attack, such as mock scenarios. St. Luke's Episcopal does STEMI drills in which EMS goes through the process of responding to a heart attack patient and bringing him or her to the hospital. The hospital films these drills so participants can identify any weaknesses and opportunities to improve the processes.
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