EMS ECG Accuracy Project Report July 2012 - Catrac
EMS ECG Accuracy Project Report July 2012 - Catrac
EMS ECG Accuracy Project Report July 2012 - Catrac
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<strong>EMS</strong> <strong>ECG</strong> <strong>Accuracy</strong> <strong>Project</strong><br />
QI Subgroup<br />
<strong>July</strong> 18, <strong>2012</strong><br />
7/18/<strong>2012</strong> ©2010, American Heart Association 2
Process Review<br />
7/18/<strong>2012</strong><br />
• <strong>EMS</strong> systems submit <strong>ECG</strong>s<br />
– WC<strong>EMS</strong> and ATC<strong>EMS</strong> (Buda FD & San<br />
Marcos/Hays Co <strong>EMS</strong>)<br />
• Cardiologist initial review – Dr. Gigliotti<br />
– Additional reviews by Drs. Wozniak and Zidar<br />
• Confirmed = 2 of 3 cardiologists<br />
• Sorted into 3 time periods<br />
Improving the System of Care for STEMI Patients<br />
3
ATC<strong>EMS</strong> Educational Intervention<br />
7/18/<strong>2012</strong><br />
• Late June – August 2011<br />
• Regional STEMI definition<br />
• ATC<strong>EMS</strong>/Regional data<br />
• Confounders & improvements<br />
• Protocol changes<br />
Improving the System of Care for STEMI Patients<br />
4
STEMI Alert Cases/Month<br />
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Negative Cases – Reasons/Confounders<br />
Feb – June 11 <strong>July</strong> – Aug 11 Sept 11 – May 12<br />
Isolated V1-V2 (9) Isolated V1-V2 (0) Isolated V1-V2 (3)<br />
LVH (4) LVH (1) LVH (5)<br />
Early Repol. (3) Early Repol. (3) Early Repol. (5)<br />
BBB (4) BBB (1) BBB (4)<br />
Non-Specific/Does not<br />
meet criteria (1)<br />
Non-Specific/Does not<br />
meet criteria (2)<br />
Non-Specific/Does not<br />
meet criteria (28)<br />
Poor Quality <strong>ECG</strong> (1) Poor Quality <strong>ECG</strong> (5) Poor Quality<br />
<strong>ECG</strong>/Artifact (8)<br />
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Negative Cases – Reasons/Confounders<br />
Feb – June 11 <strong>July</strong> – Aug 11 Sept 11 – May 12<br />
Isolated V1-V2 (9) Isolated V1-V2 (0) Isolated V1-V2 (3)<br />
LVH (4) LVH (1) LVH (5)<br />
Early Repol. (3) Early Repol. (3) Early Repol. (5)<br />
BBB (4) BBB (1) BBB (4)<br />
Non-Specific/Does not<br />
meet criteria (1)<br />
Non-Specific/Does not<br />
meet criteria (2)<br />
Non-Specific/Does not<br />
meet criteria (28)<br />
Poor Quality <strong>ECG</strong> (1) Poor Quality <strong>ECG</strong> (5) Poor Quality<br />
<strong>ECG</strong>/Artifact (8)<br />
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Degree of Agreement<br />
STEMI<br />
3 of 3 Yes<br />
STEMI<br />
2 of 3 Yes<br />
Not STEMI<br />
3 of 3 No<br />
Not STEMI<br />
2 of 3 No<br />
Feb-Jun 11 Jul-Aug 11 Sep 11-May 12<br />
52 (72%) 27 (79%) 99 (75.6%)<br />
20 (28%) 7 (21%) 32 (24.4%)<br />
18 (50%) 4 (33%) 31 (56.4%)<br />
18 (50%) 8 (67%) 24 (43.6%)<br />
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Summary<br />
• Avg. 23.8 STEMI alerts/month<br />
– 89% ATC<strong>EMS</strong><br />
– 9% WC<strong>EMS</strong><br />
• Combined <strong>EMS</strong> <strong>Accuracy</strong> = 69.9%<br />
– 16 months<br />
– 379 <strong>ECG</strong>s<br />
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Summary<br />
• Improvement areas remain (all cases)<br />
– Non Specific ST or ST Criteria not met (30)<br />
– Poor Quality <strong>ECG</strong>/Artifact (17)<br />
– LVH (8)<br />
– BBB (7)<br />
– Early Repolarization (6)<br />
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Summary<br />
• Reviewer agreement varies<br />
– 100% agreement STEMI 75% of time<br />
– 100% agreement Not STEMI 56% of time<br />
• Plan to Continue <strong>Project</strong><br />
7/18/<strong>2012</strong> ©2010, American Heart Association 14
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