Background: Mission: Lifeline is a strategic initiative to save lives and reduce disability by improving emergency readiness and response to heart attack patients. Heart disease is the number one killer in North Dakota and nationally. North Dakota consists of 53 counties over 69,001 square miles with a population of 680,000. Thirty-four entire counties are designated medically underserved areas and 13 counties have some part of them designated medically underserved. A large number of residents reside in the 36 frontier counties 21% (142,800/680,000) with a population density of < 6 people/mile, and 9 rural counties 15% (102,000 of 680,000): < 5000 residents Population density of > 6/mile together making up just over one third of the state population and 85% (45 of 53) of the physical territory. Eight urban counties with a city of at least 15,000 make up the remaining population at 63% (428,400 of 680,000). In 2011, ND M:L received a $7.1 million grant to bridge gaps in disparities in access to care by streamlining statewide STEMI systems. Methods: A statewide initiative was implemented for pre-hospital recognition, education, triage, and treatment of STEMI patients to the most appropriate reperfusion strategy. • Ninety eight percent (123 of 125) licensed ground EMS received funding to enable pre-hospital 12 lead ECG acquisition and transmission to both referral and receiving hospitals • In person facilitated education were provided to each EMS agency in 3 rounds with focus on acquisition, recognition and triaging of STEMI patients utilizing the ACC/AHA guidelines. • PCI receiving hospital physician and nurse educator teams facilitated a standardized in person clinical STEMI education session at each of the 38 referring hospitals focused on utilizing a state recommended referring hospital STEMI protocol, EMS transport guideline, and a STEMI feedback process • Six of six PCI receiving hospitals collected data utilizing the ACTION GWTG Registry Results: • In ND aggregate data from Quarter 3 2012 to Quarter 3 2013 there have been marked improvements in several measures. The ND Mission: Lifeline composite score 93% (557/ 596) to 97% (471/482) 1ST EKG obtained Pre-hospital 46% (56/122) to 76% (92/121) ED Arrival to First In-Hosp ECG % within 10 minutes 66.% (81/122) to 84% (103/122) Arrival to Primary PCI <= 90 min. from 86% (32/37) to 100% (43/43) Conclusions: To sustain STEMI system of care for patients in ND, collaboration with regional partners, care standardization, aggregate data sharing and feedback have been identified as vital. Regional champions committed to systemization are central to EMS and referral hospital engagement and state level process improvement. PCI receiving hospitals lead the way in convening regional multidisciplinary teams meetings, and facilitating data feedback on STEMI systems at a state level to support a unified platform of sustainability.
Background: Minnesota, North Dakota and South Dakota continue to build the infrastructure to improve the system of care for patients experiencing a ST-elevation myocardial infarction (STEMI). Time from symptom onset to Percutaneous Coronary Intervention (PCI) is a critical component for better patient outcomes. First responders are critical to the success of an effective STEMI system of care. However, about 52% of STEMI patients in these states are arriving by self-transport or personally owned vehicles instead of activating the system via 911. Ideally, the catheterization lab team would be notified by EMS personnel in the field or by emergency physicians after receiving the transmitted ECG indicating a STEMI and reducing the time to PCI. Methods: In time period, 774 STEMI patients were entered into ACTION Registry-GWTG from Quarter 3 2013 to Quarter 2 2014. The data included STEMI patients from 19 hospitals in Minnesota, North Dakota and South Dakota participating in Mission: Lifeline, an American Heart Association initiative to improve STEMI systems. The patients analyzed arrived directly to a PCI capable hospital. Patients transferred from a referring facility were excluded in time comparison. Arrival mode percentage comparison to first facility is the exception and includes all patients. Results: The median time from patient arrival at PCI center to catheterization lab arrival ranged between 22 and 31 minutes with a mean 26 minutes for patients arriving via EMS. Patients that came by personally owned vehicle had a median time from arrival to catheterization lab that ranged between 35 and 41 minutes with a mean of 38 minutes. The median time from hospital arrival to PCI had a mean of 42 minutes for patients arriving via EMS compared to those arriving via self-transport at 57 minutes. Conclusion: Patients arriving to a PCI hospital via EMS arrive in the catheterization lab and receive PCI faster than those arriving by personally owned vehicle. Thus, in the setting of STEMI, failure to activate EMS prolongs ischemic time.
Introduction: In predominantly rural states, effective and efficient response of Emergency Medical Services (EMS) to stroke cases is often delayed by geographically large, sparsely populated service areas and limited access to healthcare professionals and services. North Dakota is a rural state with 36 of 53 counties designated as Frontier (less than six persons per square mile) and a total population estimated at 755,393. Purpose: To identify barriers experienced by EMS professionals in North Dakota when responding to, assessing, providing care, and transporting potential stroke patients. Methods: EMS providers were recruited to participate in in-person focus groups. Four focus groups were performed (n=24) using a semi-structured interview guide. Sessions were digitally recorded and field notes with abridged transcripts were analyzed for recurrent themes using content analysis. Results: Participants were 37.5% male, 91.7% non-Hispanic White and included unpaid EMS volunteers (29.0%). Several common themes were identified, including: 1) importance of public awareness for timely recognition of stroke symptoms and the importance of calling 9-1-1 at early onset of symptoms; 2) frequent receipt of inaccurate/insufficient information from Dispatch; 3) difficulties notifying accepting hospitals due to loss of cell service in rural areas; 4) perceptions that accepting hospital staff due not trust EMS clinical assessments; 5) technical barriers and time restraints experienced when providing written and verbal patient reports to hospitals; and 6) lack of formal feedback from hospitals to EMS agencies regarding stroke patients transported by EMS agencies. Conclusions: EMS providers in North Dakota experience several challenges inhibiting their ability to provide timely pre-hospital care to stroke patients. Although several barriers were identified, most are modifiable and can be remedied with enhanced education and training focused on improving effectiveness and efficiency of EMS communications with dispatch and hospitals.
Introduction: The North Dakota Mission: Lifeline Stroke program is a 3-year initiative which aims to improve statewide stroke systems of care. Due to complexities in recognizing and treating stroke patients, effective education of prehospital and hospital health care providers on guideline-based assessments and treatment methods were identified as an essential intervention. In person lectures, conferences, workshops, stroke simulation trainings, online courses, webinars, and a stroke certification program were deployed throughout the project. Purpose: The purpose of the post-education survey was to determine the impact, value, and success of different types of education provided during the project. Methods: North Dakota healthcare professionals (n=221) completed a 20-question online survey about their experiences participating in the stroke trainings provided from 2017 to 2020. Results: Survey respondents consisted of 76 Emergency Medical Service (EMS) providers and 145 hospital-based healthcare professionals. The majority of hospital-based staff respondents were nurses (80.1%), while most EMS-based respondents were paramedics or EMTs (75.0%). Half of all respondents (49.8%) participated in 2 or more educational offerings. Respondents were asked to rank the educational offerings in which they participated in by order of the benefit to their everyday practice. The two highest ranking educational offerings were the Advanced Stroke Life Support Class (mean rank=1.6) and Simulation in Motion (SIM) ND (mean rank=2.3). More than 90% of respondents stated that these trainings were extremely or very applicable to their everyday practice. When asked about the overall impact of all the educational offerings they participated in, almost all (92.6%) respondents indicated they agree that because of the trainings they have a better understanding of the key issues related to caring for stroke patients. Conclusions: Overall, the comprehensive survey provides concrete evidence and feedback that multi-modal education campaigns are well-received and effective in furthering awareness of guideline-based stroke assessments and treatment methods. Activities with a kinesthetic learning approach were found to be especially well-received.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.