Contra Costa Stroke System Design and Implementation

Transcription

1 Contra Costa Emergency Medical Services Contra Costa Stroke System Design and Implementation Informational Meeting April 13, 2010

2 Agenda Welcome and Introductions Preliminary Stroke System Plan Stroke in Contra Costa Demographics Timeline Stroke System Advisory Group Stroke System Design & Management

3 Contra Costa EMS Stroke System Program Contacts Joe Barger, MD EMS Medical Director Patricia Frost RN, MS, PNP Assistant EMS Director Craig Stroup Prehospital Care Coordinator Stroke Project Manager

4 Stroke System: The Vision Primary Stroke System Focus Inclusive Uniform Standard of Care Strong Partnerships Prehospital Hospital Community Improvement Focused

5 Stroke System Design Principles Rapid Field Identification and Triage Communication Field Stroke Alert Timely Transport to Designated Centers Reliable Feedback Loops Stroke Education Partnerships System Metrics

6 National Stroke Statistics United States 3 rd leading cause of death 700,000 victims/year 25% mortality rate 15-30% disabled 49% patient with stroke die before hospital arrival ½ to ¾ of ischemic stroke patients do not arrive at hospital within 3 hour window for treatment

7 Contra Costa EMS Annual Statistics for Stroke Estimated EMS Volume: 940 suspected stroke cases/year 77% (723) likely stroke on case review 37% (267) within 3.5 hour window of treatment Stroke ALERT candidates 2009 EMS data

8 Total Time At Scene - Suspected Stroke Number Minutes National EMS Stroke Scene Time Goal: < 10 minutes

9 Contra Costa Emergency Medical Services Contra Costa Stroke Ethnicity (Data represents 20% sample of AMR data) Caucasian African-American Not Entered Hispanic Other 5% 4% 3% 3% 3% 1% Unknown Asian Pacific Islander 10% 71%

10 Contra Costa EMS Suspected Stroke Cases Age Range (n= 145) Age Ranges Below % Below 40 2% % % % % Data represents 20% sample of 2009 AMR data %

11 Doctor's Hospital San Pablo 7% KAISER - RICHMOND 9% KAISER - VALLEJO 1% Not Entered 1% Contra Costa Regional Medical Center 3% Contra Costa EMS Suspected Stroke Patients Receiving Facilities MT. DIABLO MEDICAL CENTER 18% KAISER - ANTIOCH 11% Sutter Delta Medical Center 14% KAISER - WALNUT CREEK 18% JOHN MUIR MEDICAL CENTER 18% MT. DIABLO MEDICAL CENTER JOHN MUIR MEDICAL CENTER KAISER - WALNUT CREEK Sutter Delta Medical Center KAISER - ANTIOCH KAISER - RICHMOND Doctor's Hospital San Pablo Contra Costa Regional Medical Center Not Entered KAISER - VALLEJO

12 Contra Costa Prehospital Stroke Care 140 Glucose documented 126 Stroke scale documented % Time of onset / last normal Number of Patients % 85 59% All 3 items documented Stroke scale/time documented % 36% suspected stroke cases (20% sample)

13 No Time documented 34% Contra Costa Emergency Medical Services Time of Stroke Onset Awoke with abnl - no time listed 8% Time of onset less than 3.5 hrs 37% Time of onset 3.5 hrs or more 21%

14 CCHP 3% Self Pay 3% Unknown 1% Health Net 4% Medi-Cal 4% Not Entered 11% Kaiser 43% Other Insurance 12% 20% sample AMR epcr data Medicare 19% EMS Transported Suspected Stroke Patients Primary Insurance

15 National Perspective Delays in Stroke Care Lack of stroke recognition and delay in calling Solution: Strong community outreach Up to 70% of stroke cases are missed by 911 dispatchers Solution: Protocols, training & metrics Up to 61% of cases are missed by EMS providers Solution: Protocols, training & metrics Lack of coordination with stroke centers Solution: Rapid stroke center access & EMS/Stroke center collaboration

16 Contra Costa Emergency Medical Services Stroke System Implementation Plan Preliminary Timeline 4/13/2010 Stroke Center Candidates Informational Meeting 9/13/2010 Criteria, Metrics Oversight Operation Plan Complete 10/5/2010-3/14/2011 Stroke Center contract development distribution 4/27/2011 BOS report 6/19/2011 EMS Stroke Triage & Destination P/P complete 7/20/2011 EMS/ED Stroke Curriculum Complete 9/16/2011 Stroke System Stroke Center & EMS Coordinator Training Wednesday, April 07, /2/2012 Stroke System Launch 4/13/2010-9/13/2010 Stroke System Design Advisory Period 10/19/2010-7/29/2011 Stroke Center Site Visit Period 7/1/ /1/2010 1/1/2011 4/1/2011 7/1/ /1/2011 9/5/ /30/2011 Prehospital & ED Stroke System Training 4/2/2010 1/1/2012 9/13/2010 EMS Pre-Stroke System Training 8/20/ /5/2011 Stroke Community Education Coalition Building Stroke System Launch Date January, 2012 Page 1

17 Primary Stroke Center Recognition JCAHO Primary Stroke Center Certification CCCEMS participation Imaging (CT/MRI) Plan for diversion Community stroke reduction plan Stroke Registry CMS, GWTG, JCAHO Informational site visit Mock stroke alert Stroke System Metrics EMS record access Stroke System Oversight Participation Designation Fee Stroke System Oversight Community Outreach

18 ReddiNet CT Diversion Monitoring CT Diversion :00:00 144:00:00 120:00:00 96:00:00 72:00:00 48:00:00 24:00:00 0:00:00 January February March April May June July August September October November December CCRMC DSP JMCON JMWC KRICH KWC KANT SRRMC SDMC Time (Hour/Min/Sec)

19 Stroke Advisory Group System Design & Management Destination: equivalent/equidistant time Time frame for Thrombolysis hours CT/Neuro Diversion Imaging back-up Tracking Thrombolytic screen Abbreviated or none? Other

20 Stroke System Advisory Group Identify within 60 days Neurologists Emergency Department Stroke Nurse Coordinators Prehospital Providers Interest groups e.g. AHA Public representative(s)

21 Advisory Group Participation Objective: Produce a high quality stroke system that is sustainable Conference Call & Meetings Timely response and feedback Advice, consultation & solution focused Future Stroke System CQI Oversight Analytical and data management support Facilitate public/community education