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Local improvement following national clinical audit workshops Auditing heart attacks Saving lives

Local improvement following national clinical audit workshops Auditing heart attacks Saving lives. Dr Andrew Wragg Barts Health. Overview. National Audits related to Acute Coronary syndromes What do they involve What are our challenges How do we use data: how does it change practice

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Local improvement following national clinical audit workshops Auditing heart attacks Saving lives

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  1. Local improvement following national clinical audit workshops Auditing heart attacks Saving lives Dr Andrew Wragg Barts Health

  2. Overview • National Audits related to Acute Coronary syndromes • What do they involve • What are our challenges • How do we use data: how does it change practice • What difference has it made

  3. What is a Heart Attack?

  4. What is a STEMI and a NON STEMI It is all about ST segment elevation

  5. More than just an angioplasty • Prompt recognition of symptoms • Heart monitoring and resuscitation • Prevent further coronary thrombosis • Reduce and reverse ischaemia • Prevent future MI • Education

  6. Overview • National Audits related to Acute Coronary syndromes • What do they involve • What are our challenges • How do we use data: how does it change practice • What difference has it made

  7. NICOR MINAP (2000) • Myocardial Ischaemia National Audit project • All patients presenting with a Acute Coronary Syndromes (ACS) • Includes STEMI, Non STEMI and non cardiac chest pain • All hospitals who receive acute admissions BCIS (1991) • British Cardiac Intervention Society Audit • Cover all angioplasty procedures • All hospitals undertaking angioplasty

  8. MINAP/ BCIS • National clinical audits of heart attack management • Hospitals, ambulance services and commissioners have a record of their management of heart attack patients • Comparative analysis against nationally agreed standards • Allows comparative data between centres and regions • Clinicians and managers can monitor and improve quality and outcomes of their local services

  9. Overview • National Audits related to Acute Coronary syndromes • What do they involve? • What are our challenges? • How do we use data: how does it change practice • What difference has it made

  10. Lots of Data and Manpower • > 100 questions in each dataset • Detailed medical and technical information • Approx 1800 PCI and 1200 MIs at LCH pa • BCIS done by medics • MINAP done by specialist nurses • IT Support needed BUT huge impact Nationally

  11. Prescription of secondary prevention medication • 5 drugs shown to improve outcome after AMI • Aspirin/ Statins/ B Blockers/ ACE I and Clopidogrel

  12. Use of secondary prevention post MI continues to improve BLT: over 97% for all therapies MINAP report 2010

  13. 30 day mortality post STEMI continues to decline MINAP report 2010

  14. Time is muscle!

  15. Relationship between time to treatment and 1-year mortality De Luca, G. et al. Circulation 2004;109:1223-1225 1791 patients with STEMI in USA % Mortality 12 10 8 Double mortality for delay of 3 hours 6 4 2 240 360 60 120 180 300 Ischaemic time (call to balloon)

  16. Key Performance targets STEMI (CQC) • Call-to-balloon (CTB) audit standard 150 mins • Door-to-balloon (DTB) audit standard 90 mins Length of stay Mortality

  17. PCI for Acute SxFour admission scenarios Admitted from the community D1 Admission to Non-PCI centre CTB D2 DTB Direct admission to PCI centre Transfer to PCI centre V device

  18. Performance time targets • Door to balloon: 80% less than 90 mins • Call to balloon: 75% less than 150 mins • Direct transfer rate: >80%

  19. How did BLT do!2009 data • Door to balloon: 85% < 90 mins • Call to balloon: 56% < 150 mins • Direct transfer rate: 50% We had to improve! • Door to balloon: 80% < 90 mins • Call to balloon: 75% <150 mins • Direct transfer rate: >80%

  20. Overview • National Audits related to Acute Coronary syndromes • What do they involve • What are our challenges • How do we use data: how does it change practice • What difference has it made

  21. HAC Daily Audit Weekly Report Straight to Lab Internal DTB<60 Straight to Table

  22. Week commencing: 10th – 16th ~February 2012 (Excluding patients who were shocked/ ventilated or initial diagnosis not STEMI) Source: Heart Attack Centre Audit Team * Excludes patients in Cardiogenic shock, ventilated or already in hospital at time of STEMI CQC targets: 75% patients call – balloon time should be <150 minutes These figures may be subject to change pending feedback from LAS and NELN hospitals abcd

  23. What was the impact?

  24. Length of stay post PCI

  25. Conclusion • MINAP and BCIS are powerful audits • Great drivers of change • Tool for transforming prognosis • C2B target worthy of its CQC point! • Great resource for local research • However, not cheap! Significant resource required to do them well

  26. Local improvement following national clinical audit workshop Dr Andrew Wragg Barts Health Acknowledgements: cardiology team/ LAS/ NELCS network/ HAC audit team/ MINAP and BCIS

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