BMC EMS NEWSLETTER

EMS NEWSLETTER

February 2018

STEMI CORNER STROKE FAST LANE TRAUMA WORLD

ACC ACCREDITATION A YEAR IN REVIEW WHAT’S NEW IN TRAUMA

Help us celebrate our new Find out what Bayshore’s Stroke Do I ac vate a level 1 or 2 trau‐
accredita on status and program accomplished in 2017, ma? Find out the difference in‐
never‐ending growth in the and what is to come in 2018. side and see our volume.
cardiovascular corner.

SEPSIS SURVIVAL

First responders are the first person in
many cases to get to these patients and it
is imperative to know what signs and
symptoms to be on the lookout for.

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Bayshore Medical Center February 2018

DID YOU KNOW?

STEMI CORNER Bayshore Medical
Center’s CV
Bayshore Medical Center Receives ACC Chest Pain Center with
Primary PCI and Resuscitation Accreditation department offers:

Bayshore Medical Center provides necessary care, resources to patients with heart  Mended Hearts Support
attack symptoms Group

The American College of Cardiology has Joseph, vice president of ACC Accredi-  Heart Failure Clinic
recognized Bayshore Medical Center for tation Services. “We commend  Cardiac Rehabilitation
its demonstrated expertise and commit- Bayshore Medical Center for its demon-
ment in treating patients with chest pain. strated commitment to providing Pasa- Gym
Bayshore Medical Center was awarded dena with excellent cardiac care.”  Yoga Classes
Chest Pain Center Accreditation with Pri-  Electrophysiology lab
mary PCI and Resuscitation in December How Did We Achieve This?
based on rigorous onsite evaluation of Hospitals receiving Chest Pain Center (with ability to complete
the staff’s ability to evaluate, diagnose with Primary PCI and Resuscitation Ac- cases with little to no x-
and treat patients who may be experienc- creditation from the ACC must take part ray)
ing a heart attack. in a multi-faceted clinical process that  Left appendage closure
involves:  ASD repair
According to the Centers for Disease  Left ventricular assist
Control and Prevention, more than completing a gap analysis with impella
730,000 Americans suffer a heart attack examining variances of care
each year. developing an action plan With the addition of these
rigorous onsite review new services, we are able
Hospitals that have earned ACC Chest monitoring for sustained success to treat more patients at
Pain Center with Primary PCI and Resus- this facility keeping them
citation Accreditation have proven excep- Improved methods and strategies of in their community and
tional competency in treating patients caring for patients include streamlining closer to family and
with heart attack symptoms and have processes, implementing of guidelines home.
primary PCI available 24/7 every day of and standards, and adopting best prac-
the year. As required to meet the criteria tices in the care of patients experiencing
of the accreditation designation, they the signs and symptoms of a heart at-
comply with standard Chest Pain Center tack. Facilities that achieve accreditation
protocols and are equipped with a robust meet or exceed an array of stringent
hypothermia program for post-cardiac criteria and have organized a team of
arrest treatment. These facilities also doctors, nurses, clinicians, and other
maintain a "No Diversion Policy" for out- administrative staff that earnestly sup-
of-hospital cardiac arrest patients. port the efforts leading to better patient
“ACC Accreditation Services is proud to education and improved patient out-
bestow Chest Pain Center with Primary comes.
PCI and Resuscitation Accreditation on
Bayshore Medical Center,” said Abraham WE COULDN’T HAVE DONE IT

WITHOUT YOU!

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Bayshore Medical Center February 2018

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Bayshore Medical Center February 2018

Sepsis is the leading cause of death in U.S. hospitals. 62% of people hospitalized with
sepsis are re-hospitalized within 30 days and as many as 92% of sepsis cases originate
in the community. Mortality from sepsis increases 8% for every hour that treatment is
delayed and as many as 80% of sepsis deaths could be prevented with rapid diagnosis
and treatment.

www.sepsis.org/downloads/2016_sepsis_facts_media.pdf

SIRS (Systemic Inflammatory Response Syndrome)

 Hyperthermia (>100.4*F) or hypothermia (<96.8*F)
 Heart rate >90 beats per minute
 Respiratory Rate > 20 breaths per minute or intubated
 Signs of poor perfusion (such as SBP <90 mm/hg)

SIRS Suspected or SEPSIS
proven infec‐

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Bayshore Medical Center February 2018

National EMS Week May 20 – 26
Emergency Medical Services for Children Day May 23

Quarterly EMS Meeting May 23 @ 12:30pm
NRP class date TBD

EMS AGENCY 2017 Transports Admit ESI 1 ESI 2 ESI 3 ESI 4 ESI
Rate 5
Acadian 6,552 37% 3% 38% 53% 6% 0%
Deer Park 866 47% 5% 46% 46% 3% 0%
Houston FD 553 2% 41% 52% 5%
La Porte EMS 442 48% 7% 38% 49% 6% 0%
South Houston EMS 350 42% 3% 36% 56% 4% 0%
Channelview FD 287 5% 41% 51% 3%
North Channel EMS 255 41% 4% 45% 49% 2% 0%
Galena Park 122 50% 0% 53% 45% 2% 0%
56% 6% 36% 55% 3% 0%
South Lake Houston EMS 100 3% 40% 52% 5%
SUMMARY 11,097 54% 0%

51% 0%

42% 0%

EMS volume –

For the month of February, we have received 831 patients via EMS, an 18% volume
increase for the month. Overall, our general ED volume is up ~ 22% from last
year. Our door to bed time is currently 9 minutes for EMS patients, on average.

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Bayshore Medical Center February 2018

HAVE YOU MET OUR EMERGEN

Dr. Rajan Parikh Dr. Bryan Kharbanda
Medical Director

Dr. Tinuola
Agbabiaka

Dr. Robert Martinez Dr. Debra Muncy
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Bayshore Medical Center February 2018

NCY DEPARTMENT PHYSICIANS?

Dr. Evan Suzuki Dr. Jessica Stewart

Dr. Marsha Tallman

Dr. Adam Tenke Dr. Richard Menaik
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Bayshore Medical Center February 2018

Improved ED staffing

We have made significant strides in improving the ED staffing to
better meet the needs of our community during this time of un-
precedented volume. At our times of highest volume, Monday
and Tuesday afternoons and evenings, we have 19 ED staff mem-
bers - including RNs, LVNs, EMTs and PCTs – on the floor assist-
ing and caring for our patients. At the same time, we have 5 Prac-
titioners in the ED (MDs and NPs) to rapidly greet and assess our
patients. This improvement in staffing has allowed us to consist-
ently greet our patients in less than 10 minutes, on average, lead-
ing to overall improved patient safety and outcomes.

Patient follow up

BMC employs staff members to “follow-up” with our discharge patients. Our goal is to at-
tempt to reach every patient who gets discharged home within 24 hours of their dis-
charge. We reach out to answer questions that may not have been addressed during
their ED visit, to verify the patient or their family member understand their diagnosis and
at-home treatment plan, and to seek out information that may help us improve the care we
deliver within the ED. We have been able to assist many patients with finding an afforda-
ble medication option, clarifying medications they have been prescribed, once even figur-
ing out a patient had lost one of the antibiotic prescriptions she had been given!

GOT QUESTIONS Patient Privacy

Contact James Bernal Planning has begun to add permanent ceiling-hung curtains
Director – Emergency Department to our hall bed locations. Permanent signage and work-
[email protected] stations will be added as well. This will improve the privacy
for our patients, and improve the workflow for all staff. Cur-
rently, materials have been ordered, and work is expected to
begin within the next month.

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Bayshore Medical Center February 2018

STROKE FAST LANE

Stroke is the 3rd leading causes of death in the United States and the leading cause of serious, long-
term disability in the United States. Each year nearly 795,000 people have a stroke and nearly three-quarters
of all strokes occur in people over the age of 65. One-fourth of strokes occur in people under the age of 65 and
the risk of a stroke more than doubles each decade after the age of 55. Here at Bayshore Medical Center our
Stroke Program provides high quality evidence based care to all patients presenting with stroke symptoms.
We work with an interdisciplinary team to make sure we are giving the highest quality of care for all stroke pa-
tients to meet and exceed goals/standards that we practice to improve patient outcomes. At Bayshore Medical
Center, we are working toward decreasing our time that we administer tPA (a clot busting agent used to treat
ischemic strokes) from 60 minutes to 45 minutes. Also with decreasing our time, we are working towards in-
creasing our goals for our delivery times to 75% for 60 minutes and 50% for 45 minutes. In 2017, we saw this
high quality of practice exceed goals with tPA administration time for less than 60 minutes at 84.3% and for
less than 45 minutes at 56.25%.

2017 TPA Times

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Bayshore Medical Center February 2018

NRP classes offered and educa on on thermal
regula on in the neonate
Level III NICU designa on

ED Year in Review

We delivered HIGH QUALITY, paƟent centered care

 100% of ED STEMI pa ents had a door to balloon me of < 90 minutes
 84% of ED Ischemic CVA pa ents had a door to TPA me of < 60 minutes
 ED and Sepsis leadership were one of 2 facili es, invited to share with CMS our pro‐

cesses around Sepsis Care. We were one of the top improvers in care delivery.

AND WE COULDN’T DO IT WITHOUT YOU!!
OUR EMS PARTNERS

Nathan Jung—Director of EMS
[email protected]
Allen Sims—Director of Emergency Services
HCA Gulf Coast Division
[email protected]

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Bayshore Medical Center February 2018

LEVEL 1 ACTIVATIONS:
MOST SEVERE INJURIES

Physiologic criteria indicating LEVEL 1 ACTIVATIONS 2017 / 2018
high-risk or life threatening
injuries:

 GCS < 8 or deteriorating
w/ mechanism attributed to
trauma

 SBP < 90 (adult)
 Age specific abnormality of

vital signs

Anatomic criteria indicating
high-risk or life threatening
injuries.

 Gunshot wound to the The initial assessment and evaluation of severely injured
head, neck, chest or abdo-
men trauma patients should begin with EMS and then seamlessly

 Any penetrating injury to transition through the emergency department and hospital
the extremities with suspi-
cion of vascular injury such phases of care. EMS should have the authority to call for a
as expanding hematoma, trauma team activation most often involving physiologic and
loss of pulse, paralysis, anatomic findings in the field.

loss of sensation or pain A Level 1 Activation always involves the trauma surgeon
 Use of blood products to who must be at the bedside for a physical evaluation within
30 minutes of initiation.
maintain vital signs
 Respiratory compromise,

obstruction or field intuba-
tion
 Flail chest Bayshore Medical Center had 38 Level 1 Activations for

 Two or more obvious prox- 2017 and 4 Level 1 Activations for 2018 YTD.
imal long-bone fractures
 Unstable pelvic fracture

resulting from trauma
 Paralysis and trauma
 Any other trauma at the GOT QUESTIONS

discretion of Charge Nurse Contact Mark Kelton
or ED Physician
[email protected]

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