COMMUNITIES FOUNDATION of TEXAS
2014 Impact Report
Case Study: Creating a Model STEMI Program The Need to Get Beyond the Luck of the Draw. If an individual had had a heart attack in Dallas County three years ago, the care was not very good, according to the American Heart Association (AHA). At the time, the Dallas County system was failing to consistently deliver optimal, seamless, and timely care to every person who falls victim to heart attack—it was the luck of the draw as to what outcome each patient would experience. Through its grant, the Caruth Foundation became—to use AHA’s analogy—the “first responder” to a call for help with an investment of $3.5 million to help change that reality. The task was challenging: diagnose, measure, and potentially overhaul every aspect of the response-and-treatment chain that is activated upon patients’ recognition of heart attack symptoms and the activation of the system. In partnership with the medical community, the AHA would design a collaborative initiative to transform patient care for the benefit of future heart-attack victims in Dallas County and to position it as a national leader in heart-attack treatment and patient survival. Focusing on the Links in the Chain of Survival. The AHA proposed creating a model program that would target heart attack patients who experience an ST-Elevation Myocardial Infarction (STEMI) heart attack—the most deadly type of heart attack. The program would address patients’ needs by concentrating on the links in the chain of survival of patients, Emergency Medical Services (EMS), emergency physicians and nurses, cardiologists, lab staff, and all area hospitals. It would establish a seamless operating STEMI system that would ensure that every Dallas County EMS provider and hospital would have the technology and training to create defined protocols within the system so that all patients received optimal treatment without delay, regardless of how they entered the emergency system. Meeting Goals and Having an Impact. In January 2013, AHA reported that it had satisfied all the grant requirements, including meeting or exceeding all benchmarks and squarely delivering on both primary grant outcomes by establishing an innovative regional collaboration that focused on the entire spectrum of care—a collaboration including convening members of all 15 Dallas County hospitals (with five competing systems) and 24 Dallas County EMS agencies. In March 2013, AHA announced that the effort successfully accomplished the following:
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stablished the first measure of the total heart attack time in Dallas County, including E patient recognition of the warning signs, the time the patient started seeking emergency care, the EMS treatment time, and the hospital treatment time known as the Symptom Onset to Arterial Reperfusion (SOAR) metric. SOAR showed a 5 percent overall improvement, down 10 minutes—from 195 to 185 minutes—after the grant was implemented ignificantly reduced the hospital emergency departments’ and cath labs’ treatment times S (door-to balloon-times) when EMS called ahead and sent patient data to the receiving hospital, saving 21 precious minutes of total treatment time—a 320 percent overall improvement
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