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					Acute Myocardial Infarction
      (AMI) Initiative
Putting All the Pieces in Place
                                         About Us

Spartanburg Regional Healthcare System

                                              585 beds – tertiary referral center
                                              • Top 100 hospital for advances in
                                                      computer technology
                                              • Bariatric Surgery Center of
                                                       Excellence
                                              • JCAHO Certified Primary
                                                    Stroke Center

                        “South Carolina’s leader in overall heart services.
                        #1 in South Carolina and North Carolina for
                        Heart Surgery”
                                                                                2
                                         Health Grades (10/16/06)
                               About Us

                                        Approximately 800 Chest
      Opened October 2004               Pain Patients per month go
                                        through our Chest Pain
                                        Clinical Decision Unit


                                           South Carolina’s 1st
                                        Certified Chest Pain Center
                                                   2003


Level One Trauma Center:
Approximately 100,000 visits annually
                                                                  3
                       Chest Pain Core Team
                                    (Meets Monthly)

Physicians:                             Other Disciplines:
    Cardiology:                             Cardiac Cath Lab:
       N. Srivastava, Medical
       Director Chest Pain Center             M. Petty, Cath Lab
                                              Manager
       R. MacDonald
    Emergency Center:                       Emergency Center:
       W. Finn, Medical Director E.C.         C. O’Hara, E.C. Clinical
       (previous)                             Director
       B. Rody, Medical Director E.C.         C. Emmerth, E.C. Clinical
       (Current)                              Unit Educator
       F. Singletary (previous)
                                            Heart Center:
       K. Hanspard (Current)
                                              S. Duggar, Interim Executive
                                              Director Cardiology/Interim CNO
                                              JT Smith, Chest Pain
                                              Coordinator
                                              B. Hunter, Cardiology Clinical
                                              Outcomes Specialist        4
                   Chest Pain Committee
                           (Meets Quarterly)

Physicians:                      Departments Represented:
    Cardiology:                       Emergency Medical Services
       N. Srivastava, Medical         (EMS)
       Director CP Center             Regional One
       R. MacDonald                   Emergency Center
    Emergency Center:                 Cardiology Administration
       W. Finn, Medical               Cardiac Cath Lab
       Director E.C. (Previous)
                                      Critical Care Inpatient Units
       B. Rody, Medical Director      Cardiac Rehab/Wellness
       E.C. (Current)
    Hospitalist:                      Laboratories
       A. Koser                       Nuclear Medicine
    Nuclear Radiologist:              Pharmacy/Drug Information
       B. Joyce                       Quality Services
                                      Vascular Services            5
    Reducing Mortality and Morbidity

Treatments are time dependent
and necessitate rapid initiation.
The patient must quickly
recognize the signs and
symptoms of an AMI.
The physician must quickly
diagnose the AMI and initiate
treatment.
                                    6
                   Reperfusion Therapy

        Treatment Delayed is Treatment Denied




 Symptom          Call to           Prehospital                           ED                 Cath Lab
Recognition   Medical System


                                                      Increasing Loss of Myocytes

                               Delay in Initiation of Reperfusion Therapy
                                                                                                          7
                                                                                            Heart
                               (Slide: American College of Cardiology Foundation / American Heart Association)
                                     STEMI Time Line
                         (1st Graph Introduced CP Core Team)

                                                   JANUARY 2005
                      ST SEGMENT ELEVATION MYOCARDIAL INFARCTION (STEMI)
                 TIME LINE FROM ARRIVAL TO FACILITY TO TIME WIRE CROSSES LESION
                                                                      GOAL: Door-to-PCI = < 120 Minutes

                            400


                            350

    Chest Pain Center       300                                             (273M)
Clinical Decision Unit
Opened October 2004
                            250
                                                                                                                   (196M)
          NUMBER OF MINUTES 200

                                                                                                 DIRECT ADMIT
                            150         (123M)
                                                    (112M)     (105M)                            TO CATH LAB
                                                                                                                               (83M)
                            100                                                        (73M)
                                                                                                     (36M)
                                50


                                0
                                     PT # 1      PT # 2      PT # 3       PT # 4      PT # 5      PT # 6        PT # 7      PT # 8

BEGIN TIME TO WIRE ACROSS LESION      10          28          17            21          16          13           21          12
CATH LAB ARRIVAL - BEGIN TIME         14          15           6            13           4          23           17          13
CODE STEMI -CATH LAB                              37                                    16
ECG - CODE STEMI CALLED                           32                                    31
ECG - CATH LAB                        81                                   237                                   154
EC ARRIVAL - CATH LAB                                         82                                                             58
D-T-ECG                               18           0           0            2            6                        4           EMS
                                                                                                                              0
                                                                                                                                       8
     Common Factors Identified as Contributing
     to Failure to Provide Prompt Therapy:


Delays in obtaining a 12-Lead ECG

Delays in decision-making

Delays in consultation of cardiologist

Delay or lack of rapidly available
serum markers for AMI
                      Society of Chest Pain Centers   9
    Common Factors Identified as Contributing
    to Failure to Provide Prompt Therapy




Delays related to gender biases

Delays related to staff perception of a
patient’s pain as noncardiac




               Society of Chest Pain Centers   10
                                % Received Thrombolytic Therapy WI
                                30 Minutes from Arrival to Facility

                                             ACUTE MYOCARDIAL INFARCTION (AMI) INITIATIVE
                               % RECEIVED THROMBOLYTIC THERAPY WITHIN 30 MINUTES OF ARRIVAL TO FACILITY
                                                                                       (Q3 FY 2006)
                                                                              (HQI - JCAHO - CMS - PREMIER)

                                                                                                                                                 HQI
                 100


                                                                                                                         MEAN TIME Q2 FY 2006 = 24.3 minutes
                                                                                                                             1 case outlier by 3 minutes
                 80        HQI: 1st (Top) Decile

                                                                                                                                                                  66.667
                                                                                                                                             66.67%
                          HQI: Top 2nd Decile
                                                                                                                                                                  (2/3)
  % COMPLIANCE




                 60                                                                                                                          57.14%




                                                             MIDAS Com parative                              JCAHO                                        No Thrombolytic
                 40
                                                                                                                                                               Given
                                                                      29.41      28.57                                                      25.0%
                                                                                                                                                            Q1 FY 2006
                                                                                             28.57
                           HQI: Top 50%                                                                                                                     Q3 FY 2006
                 20                                                                                                                              14.29
                                                                                                                                           (1/7)
                                                                                                     (0/5)
                                                                                                     0                 (0/3)
                         HQI: 8th Decile                                                                                   0      (0/2)          0%
                  0                                                                                                               0
                       Q1 FY     Q2 FY     Q3 FY       Q4 FY      Q1 FY       Q2 FY      Q3 FY   Q4 FY       Q1 FY     Q2 FY      Q3 FY     FY 2005      Q1 FY    Q2 FY       Q3 FY

Thrombolytic Therapy Rarely Given …Alternative when Cath Lab Unavailable
                       2003      2003      2003        2003       2004        2004       2004    2004        2005      2005       2005                   2006     2006        2006

                                                                                             TIME FRAME
                                                                                                                                                                                      11
                                  SRHS             HQI 1st (Top) Decile         HQI Top 2nd Decile           HQI 50%           HQI: 8th Decile           MIDAS*           JCAHO*
                                             % Received Primary PCI WI 120
                                             Minutes from Arrival to Facility

                                            ACUTE MYOCARDIAL INFARCTION (AMI) INITIATIVE
                                 % RECEIVED PRIMARY PCI WITHIN 120 MINUTES FROM ARRIVAL TO FACILITY
                                                                                         (Q3 FY 2006)
                                                                           (HQI - JCAHO - CMS - PREMIER)



                                                                                                                                                   HQI

               100                                                                                                                                           96.296   (26/27)
                                                                                                                                                                                92.593

                        HQI 1st (Top) Decile                                                                                                  88.0%
                                                                                                                                                                      91.176    (25/27)
                                                                                                                                                   81.42%
               80       HQI Top 2nd Decile

                       HQI Top 50%                                                                                                            67.19%
% COMPLIANCE




                                                                                         JCAHO                                        70.83
               60                                                                                                                               66.67
                                                            MIDAS Com parative                                                                (58/87)

                                                                                                                 53.33   53
                        HQI 8th Decile                   42.86
               40                                                                                                                             42.22%
                                                                  SRHS


                                                                         31.82                          31.58

               20                                                                           22.22


                     July 2006 no longer reporting Door-to-PPCI WI 120 Minutes
                0
                     Q1 FY    Q2 FY      Q3 FY      Q4 FY        Q1 FY     Q2 FY        Q3 FY       Q4 FY       Q1 FY    Q2 FY       Q3 FY     FY 2005       Q1 FY      Q2 FY   Q3 FY
                     2003     2003       2003       2003         2004      2004         2004        2004        2005     2005        2005                    2006       2006    2006

                                                                                             TIME FRAME
                                                                                                                                                                                          12
                                SRHS           HQI 1st (Top) Decile              HQI Top 2nd Decile         HQI 50%              HQI: 8th Decile            MIDAS*          JCAHO*
                                           % Received Primary PCI WI 90
                                           Minutes from Arrival to Facility

                                           ACUTE MYOCARDIAL INFARCTION (AMI) INITIATIVE
                                 % RECEIVED PRIMARY PCI WITHIN 90 MINUTES FROM ARRIVAL TO FACILITY
                                                                                 (Q3 FY 2006)
                                                                       (HQI - JCAHO - CMS - PREMIER)


               80

                                                                                                                                                        73.529

               70

                                                                        Chest Pain Center Clinical Decision Unit Opened Oct 2004
               60                                                        "CODE STEMI" implemented Nov 2004
                                                                                                                                        55.556
                                                                                                                                       (15/27)
               50
% COMPLIANCE




                                                                                                                                                                     48.148
                                                                                                                                                                     (13/27)
               40

                     MIDAS Com parative
                                                                                                                    33.333
               30                                          33.33         35.29
                                                                                                                   (10/30)
                                                          (5/15)         (6/17)
                                                                                                29.17                                    Mean Times:
                                                                                                (7/24)
               20
                                                                                                                                                 Q1 FY 2006 (84.3)
                                                                                                                                                 Q2 FY 2006 (79.3)
               10
                                           10.53                                                                                                 Q3 FY 2006 (88.3)
                                          (2/19)
                    SRHS0
                    (0/18)
               0
                    Q3 FY 2004     Q4 FY 2004       Q1 FY 2005         Q2 FY 2005      Q3 FY 2005            Q4 FY 2005      Q1 FY 2006            Q2 FY 2006    Q3 FY 2006

                                                                                     TIME FRAME

                                   SRHS         HQI 1st (Top) Decile       HQI Top 2nd Decile            HQI 50%     HQI: 8th Decile         MIDAS*         JCAHO*
                                                                                                                                                                               13
Cardiac Cath Lab




                   14
                                                                    STEMI Timeline
                                                                           APRIL-MAY 2006
                                             ST Segment Elevation Myocardial Infarction (STEMI)
                                           Time Line From Arrival to Facility to 1st Balloon Inflation


                                                                    140


                                                                    120
        Goal = < 90 Minutes
                                                Number of Minutes   100


                                                                    80


Cath Lab Def intions:                                               60
     Ready Time = Pt prepped/draped
     Begin Time = MD present/local given                            40


                                                                    20


                                                                     0
                                                                                                          MA             MA MA     MA   MA   MA   MA   MA   MA   MA
                                                                          APR APR APR APR APR APR APR APR
                                                                                                          Y#             Y# Y#     Y#   Y#   Y#   Y#   Y#   Y#   Y#
                                                                          #1 #2 #3 #4 #5 #6 #7 #8
                                                                                                           1              2  3      4    5    6    7    8    9   10

                "BEGIN TIME" TO "1st BALLOON INFLATION"                   28   30   33   20   28   23     18   34   31   25   20   19   17   19   17   17   21   9
                READY TIME - BEGIN TIME                                    1   4    7    1    5    3      2    5    6    3    2    9    7    2    7    2    18   3
                CATH LAB ARRIVAL - READY TIME                             10   4    13   11   9    10     10   8    9    1    4    4    6    6    4    5    4    8
                CATH LAB ARRIVAL - BEGIN TIME
                CODE STEMI -CATH LAB                                           21   12   41   25   36     47   50        22   54   29   33   57   43        52   20
                ECG - CODE STEMI CALLED                                        0    26   30   8    8      12   3         0    0    3    15   0    13             0
                ECG - CATH LAB                                            46                                        76                                 51   2
                Direct Admit - CATH LAB
                D-T-ECG                                                    3   0    2    21   4    9      3    9    14   0    1    3    6    31   0    21   0    0


                 D-T-ECG                                                       Direct Adm it - CATH LAB                       ECG - CATH LAB                            15
                 ECG - CODE STEMI CALLED                                       CODE STEMI -CATH LAB                           CATH LAB ARRIVAL - BEGIN TIME
                 CATH LAB ARRIVAL - READY TIME                                 READY TIME - BEGIN TIME                        "BEGIN TIME" TO "1st BALLOON INFLATION"
                 GOAL: Decrease Door-to-PPCI
                     Times < 90 Minutes


GOALS: “CODE STEMI” Timeline:
(Recommended by CP Core Team)


  Door-to-ECG…..5 minutes
  ECG-to-Call of “CODE STEMI”…..5 minutes
  “CODE STEMI” –to-Arrival to Cath Lab….. 30 minutes
  Cath Lab Arrival-to-Begin Time…..15 minutes
  Begin Time-to-1st Balloon Inflation…..15 minutes
                                     TOTAL: 70 Minutes

                  Goals Approved: Cardiology Physician Advisory Council
                                                                    16
GOAL: Decrease Door-to-PPCI
    Times < 90 Minutes



        Coming Attraction:
        Transmission of 12-Lead
          ECG from the field
          (EMS) or from Regional
          One via an interface
          from Life Pak 12 to a
          telephone/radio
          receiver to a ….
                             17
           GOAL: Decrease Door-to-Primary
             PCI Times to < 90 Minutes

                                   Cardiologist on call’s
                                  PDA for rapid decision
                                   to Cardiac Cath Lab




Receiving station in CP Center
CDU, reviewed by E.C. Physician
and then beamed to ….                                 18
Other AMI Indicators
                                Aspirin Received WI 24H
                                                   ACUTE MYOCARDIAL INFARCTION (AMI) INITIATIVE
                                             ASPIRIN RECEIVED WITHIN 24 HOURS OF ARRIVAL TO FACILITY
                                                                                 (Q3 FY 2006)
                                                                     (JCAHO - HQA - CMS/ Premier HQI - IHI)


                                                                         SRHS GOAL: 100% Com pliance                                       HQI
                                                                                                                                                                          100
                                 HQI 1st (Top) Decile                                                                                     99.65%
               100
                              HQI Top 2nd Decile                                                                                          98.11%     (106/109)          (99/99)
                                                          98.0                                                                                             97.248
                                                                                                  96.7
                                                                                                                                96.0
                                                                                                               96.078
                                                                    95.08              95.15                                             95.83%
                            HQI Top 50%
                                                                                                                                            94.93
               95    MIDAS Com parative
                                                                            93.01
                                                                                                                                         (393/314)
% COMPLIANCE




                     JCAHO
                                               93.75                                                                                                 93.333
                      90.28          91.8                                                                                                 90.76%
                                                                                                                                                     (98/105)
               90                 HQI 8th Decile
                     SRHS


                                                                                                                        88.39


               85




               80
                      Q1 FY     Q2 FY       Q3 FY      Q4 FY     Q1 FY      Q2 FY   Q3 FY        Q4 FY      Q1 FY   Q2 FY        Q3 FY   FY 2005     Q1 FY      Q2 FY   Q3 FY
                      2003      2003        2003       2003      2004       2004    2004         2004       2005    2005         2005                2006       2006    2006
                                                                                               TIME FRAME


                     Q3 FY 2006 Opportunities Identified:
                                     SRHS
                                     HQI:YEAR 1 BASELINE: 8th
                                                                         HQI Top 10%
                                                                         MIDAS COMPARATIVE
                                                                                                             HQI Top 20%
                                                                                                             JCAHO EXPECTED*
                                                                                                                                               HQI: 5TH (MEDIAN)


                                                                                                                                                                                  20
                                        NONE, Met Standard
                                      Beta Blockers WI 24H
                                                   ACUTE MYOCARDIAL INFARCTION (AMI) INITIATIVE
                                          BETA BLOCKER RECEIVED WITHIN 24 HOURS FROM ARRIVAL TO FACILITY
                                                                   (Q3 FY 2006)
                                                                              (JCAHO HQA - CMS/Premier HQI - IHI)
                                                                                                                                               HQI
                                HQI 1st (Top) Decile                                                                                        99.42%                      100 (84/84)
                  100                                                                                                                                   97.701
                                HQI Top 2nd Decile                                                                                          97.67%
                        96.05                                                                          95.4        94.565   97.85                             (85/87)
  SRHS                                92.92                  92.22    92.59               92.31                                                                                 98.649
                                                 91.21                           92.42
                        HQI Top 50%                                                                                                          95.2
                                                                                                                                                                                  (73/74)
                  90                                                                                                                        (337/354)
                                                                                                                        89.69               93.89%
                                                             JCAHO
   % COMPLIANCE




                         MIDAS Com parative          HQI 8th Decile
                  80                                                                                                                        81.82%



                  70



                  60



                  50
                           Q1 FY      Q2 FY      Q3 FY      Q4 FY     Q1 FY      Q2 FY    Q3 FY     Q4 FY      Q1 FY    Q2 FY       Q3 FY    FY 2005      Q1 FY     Q2 FY        Q3 FY
                           2003       2003       2003       2003      2004       2004     2004      2004       2005     2005        2005                  2006      2006         2006
                                                                                                  TIME FRAME




Q3 FY 2006 Opportunities Identified: (1 case)
                                              SRHS                              HQI Top 10%                     HQI Top 20%                          HQI: 5TH (MEDIAN)
                                   issue BASELINE: the MIDAS COMPARATIVE                                 21
                           Process HQI:YEAR 1where8th “NOW” dose was not transcribed/documented as being given
                                                                         JCAHO EXPECTED*
                                      Aspirin Prescribed @ Discharge

                                                               ACUTE MYOCARDIAL INFARCTION (AMI) INITIATIVE
                                                                   ASPIRIN PRESCRIBED AT DISCHARGE
                                                                              (Q3 FY 2006)
                                                                             (JCAHO - HQA - CMS/Premier HQI - IHI)

                                                                                                                                      HQI

                                                                                                                                     99.6%
                             HQI 1st (Top) Decile                                                                                                              99.346
                       100                                                                                                           99.08%         99.324
                             HQI Top 2nd Decile
                                                                                                                                                                          97.727
                                           98.73                                                97.6          98.551         98.43     97.26     (147/148)
                                                                     96.73              96.45                                                                (152/153)
                             HQI Top 50%
                                                                                95.24                                                                                    (129/132)
                                                             94.16                                                                   (533/548)
                       95
                                             94.12                                                                                   96.21%
        % COMPLIANCE




                                                                                                                     94.08
                                        MIDAS Com parative
                             92.05    SRHS
                       90
                             JCAHO

                                                                                                                                     86.84%

                                 HQI 8th Decile
                       85




Q3 FY 2006 Opportunities Identified: (3 cases)
                       80

♥ 1 case - Aspirin received day FY discharge; however, notFY Q2 FYin Q3 FY FY 2005 Q1 FY Q2 FY Q3 FY
              Q1 FY
              2003
                    Q2 FY
                    2003
                          Q3 FY
                          2003
                                Q4
                                   of Q1 FY Q2 FY Q3 FY Q4 FY Q1 listed Physician Discharge 2006
                                2003  2004  2004  2004    2004    2005 2005 2005   2006  2006
           Summary nor the Universal Medication Form   TIME FRAME

                                                                                                                                                                                     22
♥ 2 cases – Aspirin only ordered 8th “NOW”10%
                      SRHS
                      HQI:YEAR 1 BASELINE:
                                           as HQI Top            HQI Top 20%        HQI: 5TH (MEDIAN)
                                                      dose on admission; daily dose never ordered
                                              MIDAS COMPARATIVE  JCAHO EXPECTED*
                                     Beta Blocker Prescribed @ Discharge

                                                       ACUTE MYOCARDIAL INFARCTION (AMI) INITIATIVE
                                                        BETA BLOCKER PRESCRIBED AT DISCHARGE
                                                                                    (Q3 FY 2006)
                                                                         (JCAHO- HQA - CMS/ Premier HQI- IHI)

                                                                                                                                        HQI
                            HQI 1st (Top) Decile
                                                                                                                                      100%
                 100                                                                                                                   98.84%
                                                             98.56                 98.0               98.63
                       HQI Top 2nd Decile                                                                                     99.24                          99.398
                                                                                                                                          97.89    98.78                 98.571
                  HQI Top 50%        95.71                                                                                             (558/570)(162/164)    (165/166)
                                                              94.3              93.29              95.98              95.48
                                             93.79                                                                                                                       (138/140)
                                                                                                                                      95.56%
                 90
                  SRHS       89.62
                                                     JCAHO
                                                               HQI 8th Decile                                                          82.76%
                   MIDAS Com parative
  % COMPLIANCE




                 80




                 70




                 60




                 50

Q3 FY 2006 Opportunities Identified: (2 cases)
                         Q1 FY
                         2003
                                     Q2 FY
                                     2003
                                             Q3 FY
                                             2003
                                                     Q4 FY
                                                     2003
                                                                 Q1 FY
                                                                 2004
                                                                           Q2 FY
                                                                           2004
                                                                                        Q3 FY
                                                                                        2004
                                                                                                  Q4 FY
                                                                                                  2004
                                                                                                              Q1 FY
                                                                                                              2005
                                                                                                                      Q2 FY
                                                                                                                      2005
                                                                                                                              Q3 FY
                                                                                                                              2005
                                                                                                                                       FY 2005     Q1 FY
                                                                                                                                                   2006
                                                                                                                                                             Q2 FY
                                                                                                                                                             2006
                                                                                                                                                                          Q3 FY
                                                                                                                                                                          2006
                                                                                                TIME FRAME

♥ Both cases patient received Beta blocker morning of discharge; however, not listed
                                         SRHS                             HQI Top 10%                         HQI Top 20%                     HQI: 5TH (MEDIAN)
                                                                                                                                                                                     23
                                                                                Universal
                                 in physician’s discharge summary nor JCAHO EXPECTED* Medication Form
                                     HQI:YEAR 1 BASELINE: 8th MIDAS COMPARATIVE
                               ACE Inhibitor or ARB Prescribed @ Discharge


                                                        ACUTE MYOCARDIAL INFARCTION (AMI) INITIATIVE
                                                       ACE INHIBITOR OR ARB PRESCRIBED AT DISCHARGE
                                                                                      (Q3 FY 2006)
                                                                           (JCAHO - HQA - CMS/Premier HQI- IHI)
                                                                                                                                         HQI

                       HQI 1st (Top) Decile
                                                                                                                                        100%
               100
                          HQI Top 2nd Decile                                                                                           95%
               95                                                                                          92.31                                                             91.667

                                                                                                                                     (113/129)
               90                                                                                                                                                            (44/48)
                                                                                                                                          87.6                    91.429
                                                                                                                                                                   (32/35)
                          HQI Top 50%
               85
                                                               82.61                                                         86.11    85.51%
% COMPLIANCE




               80                                                                                                  83.721
                                                                                                                                                      80
                   SRHS        JCAHO
               75 73.58                                                                                                                            (32/40)
                                                                                          75.0

                                               72.97                           72.55
          70                                              72.0
       MIDAS Com parative
                                       68.29                                                                                         66.67%
               65
                          HQI 8th Decile
                                                                                                   64.52
               60


               55


               50

               Q3 FY 2006 Opportunities Identified: (4 cases)
                     Q1 FY
                     2003
                               Q2 FY
                               2003
                                           Q3 FY
                                           2003
                                                       Q4 FY
                                                       2003
                                                                   Q1 FY
                                                                   2004
                                                                             Q2 FY
                                                                             2004
                                                                                       Q3 FY
                                                                                       2004
                                                                                                 Q4 FY
                                                                                                 2004
                                                                                                           Q1 FY
                                                                                                           2005
                                                                                                                   Q2 FY
                                                                                                                   2005
                                                                                                                             Q3 FY
                                                                                                                             2005
                                                                                                                                      FY 2005      Q1 FY
                                                                                                                                                   2006
                                                                                                                                                             Q2 FY
                                                                                                                                                             2006
                                                                                                                                                                             Q3 FY
                                                                                                                                                                             2006

                                                                                           TIME FRAME

               ♥ Addressing reason for not prescribing an ACEI; however, not addressing
                                     SRHS                                   HQI Top 10%                    HQI Top 20%                        HQI: 5TH (MEDIAN)
                                                                                                                                                                                       24
                                   reason for not prescribing an ARB in renal patients
                                     HQI:YEAR 1 BASELINE: 8th               MIDAS COMPARATIVE              JCAHO EXPECTED*
             Action: Encourage Physicians to Use:
               HEO - Cardiac Discharge Template




ACC/AHA
Guidelines




                                               25
                                 Smoking Cessation Advice/Counseling

                                                         ACUTE MYOCARDIAL INFARCTION (AMI) INITIATIVE
                                                           SMOKING CESSATION ADVICE/COUNSELING
                                                                                      (Q3 FY 2006)
                                                                           (JCAHO - HQA - CMS/PremierHQI - IHI)

                                                                                                                                           HQI
                                                        100                               100                           100      100                   100       100    100
                          HQI 1st (Top) Decile                                                                                            100%
               100
                       HQI Top 2nd Decile
                                                      HQI Top 50%             98.46                                                        99.17                        (77/77)
                                           98.36                                                95.59      96.552
               90       96.72                                       97.1                                                                 (239/241) (86/86)
                                  94.74                                                                                                                       (78/78)
                                                                                                                                         95.42%
               80
                       SRHS
               70
                                                                                                                                         61.11%
% COMPLIANCE




                     MIDAS Com parative
               60
                                                 HQI 8th Decile

               50
                         JCAHO
               40


               30


               20


               10


                0
                        Q1 FY    Q2 FY      Q3 FY      Q4 FY      Q1 FY      Q2 FY    Q3 FY        Q4 FY      Q1 FY    Q2 FY     Q3 FY    FY 2005     Q1 FY     Q2 FY   Q3 FY

                Q3 FY 2006 Opportunities Identified:
                        2003     2003       2003       2003       2004       2004     2004         2004
                                                                                                TIME FRAME
                                                                                                              2005     2005      2005                 2006      2006    2006




                                       NONE, Met the Standard
                                      SRHS
                                      HQI:YEAR 1 BASELINE: 8th
                                                                            HQI Top 10%
                                                                            MIDAS COMPARATIVE
                                                                                                               HQI Top 20%
                                                                                                               JCAHO EXPECTED*
                                                                                                                                                 HQI: 5TH (MEDIAN)
                                                                                                                                                                                  26
               Titles/E-Mail Addresses
♥   Susan Duggar, Interim Executive Director Heart Center/Interim CNO
    (sduggar@srhs.com)

♥   Cheryl O’Hara, Clinical Director Emergency Center (cohara@ srhs.com)

♥   Bonnie Hunter, Cardiology Clinical Outcomes Specialist
    (bhunter@srhs.com)

♥   JT Smith, Chest Pain Coordinator, (jtsmith@srhs.com)

♥   Margie Petty, Cath Lab Manager, (mlpetty@srhs.com)

♥   Karen Newton, Director of Quality Services, (knewton@srhs.com)
                                                                        27
Questions????

				
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posted:1/13/2011
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