Implementation of 24h PPCI Service in QMH: Key Determinants to Success & Future Perspectives Dr Raymond H W Chan, Consultant Cardiologist Department of Medicine, Queen Mary Hospital on behalf of the QMH AMI Clinical Pathway Team 8.5.2012 Chan HWR, Lam L, Lam YM, Choi K, Chan P, Lam S, Chan K, Chan M, Hai JJ, Wong KLM, Tam F, Yung A, Wong A, Kan A, Tsang YW, Luk WS, Fan L, Lee S, Wong WF, Ng PS, Tang ML, Wong SM, Tseh E, Tong HK, Tsui SH, Chan C , Lee SWL Department of Medicine, Central Nursing Department, A& E Department QMH 急性心肌梗塞24小時通心血管手術 24h PPCI Service QMH
28
Embed
Implementation of 24h PPCI Service in QMH · 2012. 5. 29. · QMH PPCI Program part of the QMH AMI Clinical Pathway (急性心肌梗塞臨床路徑) Commenced 1.2.2007 – present
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Implementation of 24h PPCI Service in QMH:
Key Determinants to Success & Future Perspectives
Dr Raymond H W Chan, Consultant Cardiologist
Department of Medicine, Queen Mary Hospital
on behalf of the
QMH AMI Clinical Pathway Team 8.5.2012
Chan HWR, Lam L, Lam YM, Choi K, Chan P, Lam S, Chan K, Chan M, Hai JJ,
Wong KLM, Tam F, Yung A, Wong A, Kan A, Tsang YW, Luk WS, Fan L, Lee S,
Wong WF, Ng PS, Tang ML, Wong SM, Tseh E, Tong HK, Tsui SH, Chan C , Lee SWL
Department of Medicine, Central Nursing Department, A& E Department QMH
Circulation 1997: WHO Project with A population view 1985-1990
Australian Institute of Health & Welfare 9.2002: 1/2 of 48,313 events were fatal (1999-00) & 87% occurred outside hospital
LIMITATIONS: AIHW 2002 WHO 1990 MEDICARE FFS CCU Pt only
½ US AMI Pts
Mortality Trend
Mortality Trend
* * *
AMI CP – Contents
• Evidence Based Medicine
• Multi-departmental collaboration
• AMI CP Protocol - starting at the AED
• Independent audit – Independent Audit Department
• Regular appraisal & Critical Review – System
Interventions
急性心肌梗塞24小時通心血管手術 24h PPCI Service QMH
Multi-departmental
Collaboration
AED (Made
diagnosis of
AMI)
CCU On
call
(Decision x
PPCI)
Interventional
Cardiologist
Cath Lab Staff
Cath Lab a/v
Cath.
Lab
CCU
Multi-dept
急性心肌梗塞24小時通心血管手術 24h PPCI Service QMH
CCU & CW Nursing Team
Occupational Therapist
MSW
Dietitian
Physiotherapist
急性心肌梗塞24小時通心血管手術 24h PPCI Service QMH
AMI CP – Contents
• Evidence Based Medicine
• Multi-departmental collaboration
• AMI CP Protocol - starting at the AED
• Independent audit – Independent Audit Department
• Regular appraisal & Critical Review – System
Interventions
急性心肌梗塞24小時通心血管手術 24h PPCI Service QMH
AED
• AED physicians elective to CCU for 3 months
for conjoint management on AMI
• AMI CP care protocol facilitated AED nursing staffs at triage level
• AMI CP clear-cut flow-chart Rx protocol
急性心肌梗塞24小時通心血管手術 24h PPCI Service QMH
AMI CP – Contents
• Evidence Based Medicine
• Multi-departmental collaboration
• AMI CP Protocol - starting at the AED
• Independent audit – CND QMH
• Regular appraisal & Critical Review – System
Interventions
急性心肌梗塞24小時通心血管手術 24h PPCI Service QMH
Central Nursing Division & Quality &
Risk Management Team
•Review & develop SOP & Care Maps
•Root cause analysis of variances ( DNT, DBT, LOS, Mortality)
•Monitor patient delivery logistic (the AED → CCU / CCL Transit)
•Re-engineer PCI booking mechanisms
•Case manager : data acquisition, analysis, variance audit & health
education & assessment
急性心肌梗塞24小時通心血管手術 24h PPCI Service QMH
AMI CP – Contents
• Evidence Based Medicine
• Multi-departmental collaboration
• AMI CP Protocol - starting at the AED
• Independent audit – Independent Audit Department
• Regular appraisal & Critical Review –
System Interventions
急性心肌梗塞24小時通心血管手術 24h PPCI Service QMH
System Intervention
• 4 Cardiology specialty trainees were recruited into the team since 1 Jul 2007 A B C
• With effect from 31 Aug 07, we re-rectify the practice to administer Lytics in AED; Cardiology Consult was carried out only if essential. A • W.e.f. 1 July 2007, AED sent an Emergency Medicine Fellow for elective to CCU for 3m A B
• Enhanced Division communication by weekly frontline team meeting in CCU A B C
• Regular case review meetings with AED A B
• Case Manager involvement in patient education & risk factors identification C
A. Shorten DN-T B. Shorten DB-T C. Shorten LOS
急性心肌梗塞24小時通心血管手術 24h PPCI Service QMH
HIGHLIGHTS
1. Strategy of Extension of Cardiac Catherization Laboratory hours
2. 3 Nurses Deficient, How to sustain 24h PPCI - Manpower Logistics
System Intervention – Strategy of Extension
of Cardiac Catherization Laboratory hours
24 hour Emergent Cath Lab Service for PPCI 01/02/2007 9A – 5P
01/08/2008 8A – 8P
15/04/2009 24h PPCI for patients ≥ 2 Risk Factors for ICH