Saint Thomas Health Services - Saint Thomas Chest Pain and Stroke Network

Overview

According to the 2012 America’s Health Rankings with input from the CDC’s Division for Heart Disease and Stroke Prevention, Tennessee and Kentucky are ranked 39th and 44th in the nation, respectively, for death rates from heart disease and stroke and contributing factors such as obesity, smoking, and high blood pressure (http://www.americashealthrankings.org/). In the treatment of acute coronary syndrome (ACS) and stroke events, positive patient outcomes depend on the delivery of expedient emergency response. Rural regions present a special challenge with remotely located residents and under-resourced hospitals. In 2005, Saint Thomas Health (STHe) began partnering with rural facilities in medically underserved areas to establish a network of accredited chest pain centers. Saint Thomas Health Regional Network Services now includes 19 partner facilities. Three are non-rural, tertiary referral centers capable of providing advanced cardiac and comprehensive neurological services, while the other 16 are located in rural, medically underserved areas.

Impact

As of January 2013, 14 of the 19 facilities have achieved accreditation from the Society of Chest Pain Centers. Ten of the 19 have completed Stroke Network requirements and become members of the Saint Thomas Stroke Network. The Network has provided ACS education to more than 1,500 nurses and EMS personnel, and given ACS continuing medical education (CME) to more than 2,500 physicians. They have performed more than 50 mock drills for the emergent treatment and transfer of a chest pain/stroke patient. Since the Stroke Network launched in September 2009, education on stroke recognition, treatment, and transfer protocols has been delivered to physicians, nurses, and EMS providers within the entire Network service area. The Network has distributed more than 4,000 stroke and cardiac educational brochures at community events across Tennessee and Southern Kentucky.

Challenges/success factors

One major reason rural health care providers struggle to access CME nursing and EMS education is the distance they must travel to attend seminars and conferences. The Chest Pain and Stroke Network addressed this barrier by creating DVD/CD educational units for health care providers. The Network has also filmed and distributed copies of the Saint Thomas Cardiology Conference, which features prominent cardiologists from across the region. Through quality improvement, drills, and the Society of Chest Pain Centers GAP analysis tools, the Network identified opportunities to streamline the care of the cardiac/stroke patient through standardized education and protocol development. The addition of a 3G Simulation mannequin to the Network in 2010 has allowed critical skills education to be delivered to providers in their communities.

Future direction/sustainability

In May 2008, the Network – anchored by Hickman Community Hospital with STHe as a Network resource – was awarded a multi-year HRSA Office of Rural Health grant. Year one of the Network focused on quality improvements and cardiac care emergencies. The year-two focus was on the emergency response to stroke and development of Telehealth beta sites. Through a Telehealth grant and continued support of STHe, the Chest Pain/Stroke Networks have continued to grow and become a sustainable model with an additional focus on delivering telemedicine consults and follow-up visits.

Advice to others

Identify strategies and best practices among network providers to keep patients closest to home when possible and to provide an efficient model that allows a quick and seamless transfer of a patient into a tertiary facility when more specialized care is required.

Contact: Greg Pope
Vice President, Philanthropy
Telephone: 615-222-6370
E-mail: gpope@stthomas.org2012