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Electronic chest pain pathway (eCPP)
Abstract
S118
10 Epidemiological analysis of a cohort of rural and remote STEMI patients in NSW S. Faddy ∗ , M. McMullen, P. Stewart NSW Ambulance, Australia The NSW Cardiac Reperfusion strategy was commenced as a proof-of-concept in December 2007. Ambulance paramedics were authorised to deliver PHT in the outer Hunter region of NSW following confirmation of ST-elevation myocardial infarction (STEMI) by a medical specialist. This model has been expanded to include all of NSW outside of Sydney, Newcastle and Wollongong metropolitan areas. We present an epidemiological analysis of our rural and remote patient cohort. To November 2014, 564 patients have been diagnosed with STEMI. The mean age is 64.1±13.0 years and 71.8% of patients are male. Onset of symptoms predominantly occurs between 7am and 1pm. The median time from symptom onset to 000 call is 39 minutes (IQR: 15-100 minutes). Symptoms occurred at rest in 55.4% of patients with a significant number of these being woken from sleep. Paramedics reported absence of chest pain in 7.4% of patients. Of the 564 confirmed STEMI patients, 328 (58.2%) have gone on to be thrombolysed in the field. Post-PHT complications were rare with cardiac arrest in eight (2.4%) and prehospital or ED department mortality in 3 (0.9%) patients. Reasons for STEMI patients not being thrombolysed in the field included timely access to primary PCI (19.5%), no return call or delayed return call from the medical specialist (8.3%), inability of the paramedics to cannulate (5.9%) and proximity to a suitable ED (4.7%). Transmission failure was the reason for not administering thrombolysis in only 1.8% of STEMI patients. This study describes the epidemiological characteristics of rural STEMI patients seeking ambulance care. http://dx.doi.org/10.1016/j.hlc.2015.06.011 Nursing Prize Finalists (11–14) 11 Do cardiac rehabilitation programs offer cardiopulmonary resuscitation training in Australia and New Zealand? S. Cartledge 1,2,∗ , J. Bray 1,2,3 , J. Finn 1,3 1 Monash
University, Melbourne, Australia Health, Melbourne, Australia 3 Curtin University, Perth, Australia 2 Alfred
Background: Cardiac rehabilitation (CR) is an ideal environment to train high-risk cardiac patients and their families in basic life support, including cardiopulmonary resuscitation (CPR). However, whether this training is currently offered is unknown. Aim: 1) To describe the prevalence of CPR training in CR programs in Australia and New Zealand and 2) to exam-
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .
ine perceived barriers and attitudes towards providing CPR training. Methods: We conducted a cross-sectional online survey of Australian and New Zealand CR coordinators. Results: Of 542 survey requests successfully emailed, 253 (47%) completed the survey (Australia n=208, New Zealand n=45). CPR training was included in 24% of Australian CR programs and 57% in New Zealand. In both countries CR programs were predominantly hospital-based, but there were higher rates of stand-alone CR programs in New Zealand (24% vs 3%, p<0.05). New Zealand also provided more face-to-face CPR training (30% vs 17%, p<0.05) and family members attended CR more regularly (49% vs 29%, p<0.05). Common barriers to CPR training included a lack of resources (39%) and not considering including it in the program (24%). The majority of respondents believed that lay people should be trained in CPR (96%) and were comfortable with recommending CPR training to this high-risk group (89%). Conclusions: While CR coordinators have positive attitudes towards CPR training, it is not currently part of the CR program for many centres, particularly in Australia. This may in part be explained by organisational differences and the specific inclusion of CPR training in the New Zealand CR guidelines. http://dx.doi.org/10.1016/j.hlc.2015.06.012 12 Electronic chest pain pathway (eCPP) A. Tiberio 1,∗ , A. Brown 2 , A. Lee 1 , G. Femia 1 , T. Fetahovic 1 1 Illawarra
and Shoalhaven Local Health District (ISLHD), New South Wales, Australia 2 SESIH eMR FirstNet, Australia The most common Emergency Department (ED) presentation across Australia is chest pain. Early identification, diagnosis and treatment are paramount to prevent adverse patient outcomes or death. This project aimed to create an Electronic Chest Pain Pathway (eCPP) and to improve its compliance/documentation to 100%, reduce acute coronary syndrome (ACS) morbidity/mortality, and decrease ACS patients’ ED lengths of stay (LOS) to <4 hours. Using the existing NSW Health Chest Pain Pathway and current Australian guidelines on the management of ACS, the Illawarra-Shoalhaven LHD (ISLHD) eCPP Project Team developed and trialled an eCPP at a local tertiary hospital (Wollongong) and a rural base hospital (Shoalhaven) in collaboration with the respective Emergency Departments(ED). As the first successful eCPP in Australia, it has proven an invaluable tool in the assessment and treatment of ED chest pain presentations, resulting in a 400% increase in compliance, no reported adverse outcomes for patients managed with the eCPP, and a 30% reduction in ED LOS. ISLHD is working in partnership with the Agency for Clinical Innovation (ACI) to rollout this evidence-based tool across NSW. http://dx.doi.org/10.1016/j.hlc.2015.06.013
S118
10 Epidemiological analysis of a cohort of rural and remote STEMI patients in NSW S. Faddy ∗ , M. McMullen, P. Stewart NSW Ambulance, Australia The NSW Cardiac Reperfusion strategy was commenced as a proof-of-concept in December 2007. Ambulance paramedics were authorised to deliver PHT in the outer Hunter region of NSW following confirmation of ST-elevation myocardial infarction (STEMI) by a medical specialist. This model has been expanded to include all of NSW outside of Sydney, Newcastle and Wollongong metropolitan areas. We present an epidemiological analysis of our rural and remote patient cohort. To November 2014, 564 patients have been diagnosed with STEMI. The mean age is 64.1±13.0 years and 71.8% of patients are male. Onset of symptoms predominantly occurs between 7am and 1pm. The median time from symptom onset to 000 call is 39 minutes (IQR: 15-100 minutes). Symptoms occurred at rest in 55.4% of patients with a significant number of these being woken from sleep. Paramedics reported absence of chest pain in 7.4% of patients. Of the 564 confirmed STEMI patients, 328 (58.2%) have gone on to be thrombolysed in the field. Post-PHT complications were rare with cardiac arrest in eight (2.4%) and prehospital or ED department mortality in 3 (0.9%) patients. Reasons for STEMI patients not being thrombolysed in the field included timely access to primary PCI (19.5%), no return call or delayed return call from the medical specialist (8.3%), inability of the paramedics to cannulate (5.9%) and proximity to a suitable ED (4.7%). Transmission failure was the reason for not administering thrombolysis in only 1.8% of STEMI patients. This study describes the epidemiological characteristics of rural STEMI patients seeking ambulance care. http://dx.doi.org/10.1016/j.hlc.2015.06.011 Nursing Prize Finalists (11–14) 11 Do cardiac rehabilitation programs offer cardiopulmonary resuscitation training in Australia and New Zealand? S. Cartledge 1,2,∗ , J. Bray 1,2,3 , J. Finn 1,3 1 Monash
University, Melbourne, Australia Health, Melbourne, Australia 3 Curtin University, Perth, Australia 2 Alfred
Background: Cardiac rehabilitation (CR) is an ideal environment to train high-risk cardiac patients and their families in basic life support, including cardiopulmonary resuscitation (CPR). However, whether this training is currently offered is unknown. Aim: 1) To describe the prevalence of CPR training in CR programs in Australia and New Zealand and 2) to exam-
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .
ine perceived barriers and attitudes towards providing CPR training. Methods: We conducted a cross-sectional online survey of Australian and New Zealand CR coordinators. Results: Of 542 survey requests successfully emailed, 253 (47%) completed the survey (Australia n=208, New Zealand n=45). CPR training was included in 24% of Australian CR programs and 57% in New Zealand. In both countries CR programs were predominantly hospital-based, but there were higher rates of stand-alone CR programs in New Zealand (24% vs 3%, p<0.05). New Zealand also provided more face-to-face CPR training (30% vs 17%, p<0.05) and family members attended CR more regularly (49% vs 29%, p<0.05). Common barriers to CPR training included a lack of resources (39%) and not considering including it in the program (24%). The majority of respondents believed that lay people should be trained in CPR (96%) and were comfortable with recommending CPR training to this high-risk group (89%). Conclusions: While CR coordinators have positive attitudes towards CPR training, it is not currently part of the CR program for many centres, particularly in Australia. This may in part be explained by organisational differences and the specific inclusion of CPR training in the New Zealand CR guidelines. http://dx.doi.org/10.1016/j.hlc.2015.06.012 12 Electronic chest pain pathway (eCPP) A. Tiberio 1,∗ , A. Brown 2 , A. Lee 1 , G. Femia 1 , T. Fetahovic 1 1 Illawarra
and Shoalhaven Local Health District (ISLHD), New South Wales, Australia 2 SESIH eMR FirstNet, Australia The most common Emergency Department (ED) presentation across Australia is chest pain. Early identification, diagnosis and treatment are paramount to prevent adverse patient outcomes or death. This project aimed to create an Electronic Chest Pain Pathway (eCPP) and to improve its compliance/documentation to 100%, reduce acute coronary syndrome (ACS) morbidity/mortality, and decrease ACS patients’ ED lengths of stay (LOS) to <4 hours. Using the existing NSW Health Chest Pain Pathway and current Australian guidelines on the management of ACS, the Illawarra-Shoalhaven LHD (ISLHD) eCPP Project Team developed and trialled an eCPP at a local tertiary hospital (Wollongong) and a rural base hospital (Shoalhaven) in collaboration with the respective Emergency Departments(ED). As the first successful eCPP in Australia, it has proven an invaluable tool in the assessment and treatment of ED chest pain presentations, resulting in a 400% increase in compliance, no reported adverse outcomes for patients managed with the eCPP, and a 30% reduction in ED LOS. ISLHD is working in partnership with the Agency for Clinical Innovation (ACI) to rollout this evidence-based tool across NSW. http://dx.doi.org/10.1016/j.hlc.2015.06.013