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Accordion Section Title
Acute Cardiac Ready Hospital Application
Accordion Section Title
Acute Cardiac Ready Hospital Designation Criteria

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PRE-HOSPITAL CARE

  • Collaboration with local EMS to allow for pre-hospital activation of STEMI process
  • Documentation supporting hospitals reaching back to EMS to provide patient outcomes, what went well, opportunities for improvement on cardiac arrest calls (feedback forms, integration of quarterly meetings, etc.)
  • EMS to provide current contact information to hospital facility

EMERGENCY ASSESSMENT OF STEMI PATIENTS

  • ED triage protocol that includes a stat ECG (<10 minutes after arrival) for patients with
  • Acute Coronary Syndrome (ACS) based signs and symptoms, including atypical presentations
  • ED treatment protocol(s) for diagnosis and treatment of the STEMI patient
  • STEMI activation plan
  • STEMI Team with required experience or competency/skills validation in STEMI care
  • STEMI Team ACLS certified
  • STEMI Team response to bedside <20 min.
  • Acute Cardiac Team members have one-hour training and education annually specific to
  • STEMI recognition, identification, treatment, and transfer (not including BLS or ACLS recertification)

TREATMENT

  • Documentation of reperfusion strategy(ies) (Fibrinolytics vs Primary PCI)
  • Protocol that outlines each step in STEMI treatment and transfer process that follows
  • current clinical practice guidelines (Examples include goal metrics for Door to ECG within 10 minutes of arrival, Door to transport activation and Door-in to Door-out within 45 minutes, Arrival to Thrombolytics within 30 minutes)
  • Documentation by provider on why the patient did not receive fibrinolytic therapy
  • Provide STEMI order sets which include current clinical practice guidelines
  • Ensure consent for fibrinolytic therapy (oral/emergent)

FIBRINOLYTIC THERAPY

  • Provide order sets/protocols for fibrinolytic therapy administration
  • Documentation of fibrinolytic checklist use
  • Documentation of the process in place when the STEMI patient is not eligible for fibrinolytic therapy
  • Documentation of annual Tenecteplase (TNK) administration refresher for STEMI Team
  • IV TNK available 24/7 (Recommend: 2 doses TNK available)
  • North Dakota STEMI Referring Hospital Center Designation Requirements – Version 7/2021

TRANSFER PROCESS

  • Transport plans or agreement for STEMI patient to be transferred to a PCI capable center
  • Documentation where expected length of stay in ED for STEMI patients transferred for PCI > 45 minutes (Door-in to Door-out)

PERSONNEL

  • STEMI Coordinator name and leadership roles specific to STEMI Systems of Care
  • Name of Medical Director/Physician Champion and leadership roles specific to STEMI Systems of Care
  • Designated smoke free campus

PROCESS IMPROVEMENT

  • STEMI activation log
  • Process improvement documentation, keeping track of quality metrics and addressing outliers, why the metric is an outlier, and what has been done to improve outliers
  • Report metric data at interdisciplinary meeting (including EMS personnel), can be built into an already existing quarterly meeting or can be a meeting on its own.
  • Use of cardiac registry with capabilities for state reporting
  • Performance improvement program must include, but not limited to, tracking the following metrics:
    • Door to ECG within 10 minutes
    • STEMI positive ECG to EMS transport activation within 10 minutes
    • Door to fibrinolytics (in fibrinolytic eligible patients) <30 minutes
    • Door-in door-out time (length of stay) < 45 minutes
    • Aspirin given prior to transfer
    • Loading dose of Plavix or Brilinta prior to transfer
    • Loading dose of weight-based Heparin
    • If fibrinolytics given, initiation of Heparin drip
  • Review of hospital and pre-hospital STEMI care

RECOMMENDATIONS:

  • Documentation supporting annual public awareness campaign provided to community
  • Outreach to local dispatch regarding pre-arrival CPR instruction
  • Participation in Cardiac Arrest Registry to Enhance Survival (CARES)

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Accordion Section Title
North Dakota Approved Cardiac Certification Programs for STEMI Receiving Center Designation

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American College of Cardiology (ACC)
  • Chest Pain Center with Primary PCI
  • Chest Pain Center with Primary PCI & Resuscitation
Accreditation for Cardiovascular Excellence (ACE) Cath/PCI
American Heart Association/The Joint Commission
  • Primary Heart Attack Center
  • Comprehensive Cardiac Center
DNV Chest Pain Program Certification (CPP)
  • STEMI Receiving Program/PCI Capable
Other Certification (Please contact North Dakota Health and Human Services (cgreff@nd.gov) before selecting this option.

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Accordion Section Title
Submit Acute Cardiac Ready Hospital (ACRH) Designation
Accordion Section Title
Acute Cardiac Ready Hospital Webinar