2017 EMS Recognition Application Transcript
Operator: / Welcome and thank you for standing by. At this time all participants will be in listen-only mode until the question and answer portion of today's conference. At that time, if you would like to ask a question, you may press star followed by the number one on your phone and record your name clearly when prompted. As a reminder today's call is being recorded. If you have any objections you may disconnect now. Now I would like to introduce your host, James Lugtu. You may now begin.James Lugtu: / Thank you, operator. Welcome everyone to our 2017 EMS Recognition Webinar. My name is James Lugtu. To begin this conference I'd like to introduce our EMS National Program Manager, David Travis, who'll be leading our call. David?
David Travis: / Thank you, James. On behalf of the American Heart Association and Mission: Lifeline, we thank everyone for joining us today to talk about EMS Recognition. This is the second webinar we've had in support of EMS Recognition for 2017 and the previous webinar is available within our resources page, our Mission: Lifeline webpage.
Our objectives today are to provide you with an overview of the 2017 Mission: Lifeline EMS Recognition criteria which is, as far as achievement goes, the same as the previous years but we do have a new 'plus' measure and reporting measures. To provide you with an overview of the data collection worksheet and to provide you with a walk-through of the 2017 EMS recognition application, which is an online application. Then of course, at the end, we'll answer any questions you may have about the Mission: Lifeline EMS Recognition Program.
Our speakers today are Tami Swart, who's a Senior Director for Quality Systems Improvement with our Western States Affiliate; Ben Leonard, who's an AHA EMS Director and Quality Systems Improvement Director for the Mid-West Affiliate; and myself, Dave Travis. I'm the Program Manager for EMS out of the National Center.
The goal of this EMS Recognition Program with Mission: Lifeline, is to recognize the EMS agencies for their role in a system of care for patients who have these time-sensitive conditions. We've been focusing primarily on STEMI for the first few years and we're now expanding to include stroke and post-resuscitation with our recording measures this year.
2017 will be the fourth year of the American Heart Association's Mission: Lifeline EMS Recognition Program. This year for 2016 we had more than 540 EMS agencies that did receive an award. We had an additional 400 more team agencies who are included in applications towards those awards. The participation has grown steadily each year and we love to see that.
This year's award list in the JEMS magazine was more than eight pages long. Our plan is to continue to publish the lists of award recipients in JEMS and we're hoping we'll have an even larger ad for 2017.
This year we had 266 agencies receive gold awards, 147 received silver, and 133 received a bronze recognition. This map displays the number of awards by state with Texas, Ohio, and Pennsylvania leading the way. Also a lot of participation in Virginia and North Carolina and some of the other states within the Mid-West.
An important date to remember with regards to EMS Recognition is when the application period opens up and when it ends. It will open on January 1st and remain open through March 31st. I will say that agencies tend to wait until the very end to make their applications. Last year I think we had about half of the applications done and entered into the system around March 10th, with the whole half being received after that time. The problem with that is if you make a mistake or if you need to go back and make a correction, you don't leave yourself a lot of time. We advise agencies, the sooner they can apply, the better. As I mentioned previously, the criteria for award achievement for 2017 is the same as it was last year and in previous years. However, we do have a new 'plus' measure this year for higher award distinction. As I said there are also new recording measures this year as well. Those recording measures do now include two for stroke and two for resuscitation, which is something new.
As far as resources go, on the Mission: Lifeline home page which is Heart.org/missionlifeline, there's an EMS provider tab. If you click on that tab it will bring you to a list of information for EMS providers including this link for Mission: Lifeline EMS Recognition resources. We have an FAQ back there, different types of resources including the worksheet that Ben will speak about in a little bit. We have a PDF that the application that Tami is going to go through, and other resources there as well to help answer any questions you might have about the program.
The achievement measures for an award are, again, the same as they've been. Achievement measure one is the percentage of patients with non-traumatic chest pain who are 35 years or older who were treated and transported by EMS, and who received a pre-hospital 12-lead ECG. Then, you have to either report on achievement measure two or achievement measure three, depending on where you transport your STEMI patient. If you transport to a STEMI receiving center, you would report on achievement measure two and that's the percentage of STEMI patients treated and transported directly to a STEMI receiving center with a pre-hospital first medical contact to device on less than or equal to 90 minutes. If you transport to a referring hospital that is non-TCIP [inaudible 00:06:51] it's the percentage of living eligible STEMI patients, treated and transported to a STEMI referring hospital for fibrinolytic therapy with a door-to-needle time of less than or equal to 30 minutes. If you transport to both types of hospitals of STEMI patients, you need to include measures two and three.
It's been our experience the last few years that most of the agencies who are applying are recording on achievement measures one and achievement measure two but we still do have some reporting on measure three as well.
This year we have a new 'plus' measure and the 'plus' means that you can get a distinction on your award. If you get a bronze you can get a bronze 'plus' award or silver or gold 'plus' et cetera if you report on an achievement of 75% performance on this measure. This measure is the percentage of 12-lead ECGs performed on patients in this field, who had an initial component of non-traumatic chest pain, 35 years or older, who received that 12-lead ECG within 10 minutes of the EMS arrival to the patient. The inclusion part here, I guess, is patients with non-traumatic chest pain, 35 years of age or older who were transported; and then the numerator is the total number of those patients in the denominator that received a pre-hospital 12-lead within 10 minutes of EMS arrival. Please note it is within EMS arrival, not first medical contact. For this award only, the definition is EMS contact with a 12-lead, and that's explained a little further in the guide and other resources.
All right, so the reporting measures are optional. We have eight of them this year. Though they are optional, they are encouraged. Some agencies may not collect data on all of these or some of these. We are asking if you do collect data and can report on these measures, that you do so. The first reporting measure is the percentage of hospital notifications or 12-lead transmissions suggesting a STEMI alert or [inaudible 00:09:01] activation, that are performed within 10 minutes of the first STEMI positive 12-lead that was performed in the field. The inclusion criteria, patients assessed and transported by EMS who had a STEMI positive ECG; and then the numerator is the total number of those patients to whom a successful notification of STEMI, or, transmission of the 12-lead occurs within 10 minutes of the first STEMI positive ECG. Tami will be going through the application, this one is set up in the application just like the achievement criteria where you actually enter the patients.
Reporting measure two, this is the first of our stroke measures also this year. Again, it's an optional reporting measure. This is the percentage of patients with a suspected stroke for whom EMS provided advance notification to the receiving hospital. The inclusion criteria is, patients who are accepted and transported by EMS and had an EMS inspected stroke; and the numerator is the total number of those patients for whom an advance notification of stroke was provided to the destination hospital. You can call it a stroke alert, a [co-stroke 00:10:15], however you term it, whether or not that was performed for a suspected stroke patient.
Reporting measure three is also a stroke measure. This is the percentage of patients with a suspected stroke who, evaluated by EMS, had an EMS documented 'Last Known Well' time. Some places call that the 'time of symptom onset for stroke' and we like to consider the last time the patient was seen well without symptoms, so it's very important with regard to administration of [fibrinolytic 00:10:50] and other procedures to know, when that time was. This is the measure. The inclusion criteria of patients who were set and transported by EMS who had an impression of suspected stroke; and then the numerator would be the total number of patients among those for whom EMS documented the 'Last Known Well' time.
Reporting measure four is the percentage of out of hospital cardiac arrest patients with sustained ROSC, maintained to arrival, at the emergency department, who had a 12-lead ECG performed. This is the first of our reporting measures in the out of hospital cardiac arrest realm. It's beneficial for those patients to get a 12-lead. On many times they are STEMIs and need to go to the [inaudible 00:11:42] so, this is our new reporting measure and the first for resuscitation. The inclusion criteria are, patients without a hospital cardiac arrest who have ROSC that was maintained until arrival of the [ECG 00:11:57]. If you just have transient [inaudible 00:12:00] pumping and circulation, that doesn't count. The numerator, the total number of those patients for whom EMS performed, a [inaudible 00:12:08].
Reporting measure five is another resuscitation measure. This is the percentage of out of hospital cardiac arrest patients with sustained ROSC, maintained to the arrival to the emergency department, who were transported to a PCI capable hospital. Now we know that this isn't possible in all areas of the country but if there's an opportunity, it's better for these patients to go to a PCI hospital, if possible. The inclusion criteria of patients without a hospital cardiac arrest or the return of spontaneous circulation, maintained to arrival of the ECG; the numerator is the total amount of those patients transported to a hospital that is PCI capable.
All right, reporting measure six is very similar to our first achievement measure. This is the percentage of 12-lead ECGs performed on patients in the field who had an initial complaint consistent with acute coronary syndrome. It's taking it a step further beyond just [inaudible 00:13:14] patients, so our inclusion criteria are patients 35 years of age or older, who have had symptoms consistent with acute coronary syndrome. Those are defined by age, chest pain, discomfort, pressure and tightness of [inaudible 00:13:31], pain or discomfort in one or both arms, the jaw, neck, back, or stomach, shortness of breath, dizziness or lightheadedness, nausea, and diaphoresis. Those are symptoms that comprise acute coronary syndrome. We know that this may be a little bit difficult for some agencies to clearly screen out but we feel that this is an important activity that is not limiting 12-lead ECGs in chest pain patients, so this is a reporting measure for this year. The numerator would be those patients in that group who did receive a 12-lead ECG.
Reporting measure seven, is the percentage of patients who initially transported to a referring hospital, a non-PCI hospital, who were later transported by the same agency to a receiving center with an EMS first medical contact, a PCI time of less than or equal to 120 minutes. This is a measure for agencies who routinely transport to referring hospitals, maybe there is no PCI hospital within their service area, yet they have good agreements between those facilities so that those patients are transported out; and we recognize that EMS has a role in that. We would like to see how agencies can report on this measure as well. The inclusion criteria is, the percentage of STEMI patients initially transported to a non-PCI or referring hospital who are later transported to a STEMI receiving hospital that is capable of PCI. The numerator is the total number of those patients with first method of contact time by EMS, the device activation, and the primary PCI, within 120 minutes. That is reporting measure seven and won't apply to all agencies, but we're looking to see if agencies can report on that as well.
Our last reporting measure is reporting measure eight. Which is, the percentage of patients with non-traumatic chest pain 35 years or older who were treated and transported by EMS who received Aspirin; and this was decided by EMS Administration, Dispatch Inspection, or patient self-administration prior to the call et cetera. The inclusion criteria would be, patients with non-traumatic chest pain 35 years of age or over and transported by EMS for whom Aspirin was indicated. The numerator is the number of those patients who received Aspirin either by self-administration, dispatch assisted instruction, or EMS provided administration. The Aspirin was actually documented in the EMS report.
These reporting measures, as I said, are optional; however, we are looking at these and other measures to become achievement measures in the future. If you are able to report on these or think about being able to collect the data, so that you're able to report on these in the future, it might be good if you want to participate in EMS recognition; because these could become achievement measures in the future.
Something that is new with the program for 2017, is that agencies who are unable to meet the [volume 00:17:10] requirements for a bronze award with all of your 2016 data; remember with EMS Recognition for 2017 we're using 2016 data, if agencies don't meet that volume requirement which is four a year or two patients in any one quarter with a total of four in a year, they can use quarters from 2015 as well. For example, if the volume of criteria is not met using quarters one to four for 2016 they can go back to 2015 using quarters four, three, two, and one; whichever quarters they need up to the full year, to achieve the sufficient volume requirements. That's new. When Tami goes through the new application in just a moment, you'll see how we've set that up so you can report that. Again, most agencies will not be using 2015 data at all, they'll just be using 2016; however, those who need that extra time frame to achieve volume, this is one way we're trying to facilitate those agencies that are very low volume. The only other caveat I should mention is that those patients cannot have been used in a previous EMS Recognition application which did result in an award. That's the criteria for that.
For the actual awards, 75% is our threshold for [all awards 00:18:46]. For bronze you need a 75% compliance and again, you need at least two patients that are reporting and four total STEMI patients in a year. Those low volume agencies can use 2015. For silver, we have aggregated annual score achieving a minimum 75% compliance for each required measure, so for silver it's aggregated and the volume you have to have at least eight STEMI patients in 2016. For gold award, it's the same criteria as the silver, however, you must have achieved a silver award in 2016. To achieve the bronze, silver or gold 'plus', you must meet the perspective threshold for the award and you must report on the 'plus' measure with at least a 75% compliance.
We have three application types. We have the individual application, a joint application, and the individual with the team options. The individual application is for agencies that do the 12-lead and transport. The joint application is for two agencies where, one does the 12-lead and one does the transport, and then they apply on the data on those patients that both agencies touch together. Then there is an individual application with the team options, which is the same as an individual application but it gives you the opportunity to name those medical first responders, non-transport, and agencies et cetera, who respond to your calls but don't have 12-lead or transport.
Again, our website is Heart.org/missionlifeline or if you just Google EMS Recognition Mission: Lifeline, it will get you there. My e-mail is or you could e-mail
I'll be happy to answer any questions as we move along. I'm going to now give you to Ben Leonard, who is a Senior Quality Systems Improvement Director for the Mid-West.