Opinion: 15 July 2015.
Why collaboration is important and what can be achieved: focus on the State Cardiac Reperfusion Strategy.
Every year, more than 50,000 people suffer heart attacks in Australia. That’s about one heart attack every 10 minutes. If a person’s cardiac symptoms are due to a blocked artery, the sooner the blockage is removed, the greater the chances of recovery and less long-term damage.
Reperfusion, the restoration of blood flow to the heart muscle, should occur as quickly as possible. Time is muscle: the more time it takes to treat a person who has had a heart attack, the more likely it is that damage to heart muscle will occur.
Collaborations underpin our healthcare system – from partnerships between paramedics within a single ambulance to the nurses, doctors and allied health staff who work together in a cardiac catheter laboratory, to the network of teams and managers that together enable a hospital to deliver safe, effective care.
We now know that collaboration between medical experts, paramedics and local clinicians is the best tool we have to save time, save heart muscle and save people who have had a heart attack, especially when those people live in remote areas of the country.
The Agency for Clinical Innovation, NSW Ambulance and Local Health District teams have introduced the State Cardiac Reperfusion Strategy (SCRS) to enhance this collaboration, and ultimately to contribute to improved care for people across NSW.
The Strategy is optimising advances in technology and treatment options to improve care and save the lives of people who have had a heart attack. Most significantly, it capitalises on collaboration between ambulance and other emergency personnel, clinicians and cardiac experts – all of them trained professionals.
They may be on hand to treat people who have had a heart attack, or they may be assessing and interpreting ECG readings hundreds or thousands of kilometres away from those patients. The Strategy is made possible by 21st-century technologies that enable healthcare professionals to communicate with each other, transmit information, and discuss results and treatment options, no matter where they are located.
The strategy has four components.
The Pre-hospital Assessment for Primary Angioplasty (PAPA) model involves patient assessment and ECG transmission to a cardiologist. If ST Elevation Myocardial Infarction (STEMI) is confirmed, the patient is immediately transported to the cardiac catheterisation laboratory (CCL) to open the artery, bypassing the Emergency Department and hospitals that do not have a CCL. There are 11 PAPA centres across metropolitan Sydney, Wollongong and the Newcastle region. Canberra Hospital provides a PAPA service for some patients in Southern NSW.
In more remote locations, paramedics enact the second model – Pre-Hospital assessment and Thrombolysis (PHT). In this model, the ECG is transmitted to a cardiologist or emergency physician who provides a reading service within the nearest Local Health District. If a STEMI is confirmed and the patient meets specific criteria, the paramedics administer medication to dissolve the blood clot and open the artery. The patient is then transferred to the nearest hospital for ongoing monitoring, rehabilitation and recovery
Nurse Administered Thrombolysis (NAT) model is an option for small hospitals that do not have 24 hour on-site medical cover where patients self-present. Clinicians transmit the ECG to a cardiologist or emergency physician for interpretation. If STEMI is confirmed and the patient meets specific criteria, protocol directed thrombolysis is administered by nurses, to dissolve the blood clot and open the artery. If the patient has another diagnosis, advice on patient management is provided.
The Clinical Support Model provides care for patients who self-present to small hospitals. An ECG is sent to the relevant reading service and rapid clinical advice is provided to local clinicians to assist in managing the patient’s symptoms.
All elements of the strategy are being evaluated by the ACI against measures reflecting outcomes for patients, staff and health services, so that better practices can be continuously identified and promoted across NSW.
This strategy is about saving lives. If you suspect you are having a heart attack, call Triple Zero (000). This call will activate the SCRS. A team of experts will work together – across town, perhaps in the next town or even across the other side of the state. This collaboration could mean the difference between life and death.
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About the author
Dr Nigel Lyons has almost 30 years’ experience in the NSW Health system as a clinician, manager and executive. He is the Chief Executive of the NSW Agency for Clinical Innovation, a Board governed statutory health authority charged with the responsibility of involving multidisciplinary networks of clinicians and consumers to design and promote better healthcare for NSW.
He has also held other executive roles in the NSW Ministry of Health and NSW Health Services including Chief Executive of Hunter New England Area Health Service.Dr Lyons has been actively involved during his career in many other roles which demonstrate a commitment to postgraduate education, rural health and clinical service improvement at regional, state and national level.He has also held a number of Board appointments relating to these areas during his career and is currently a member of the Board of the NSW Bureau of Health Information.
Find out more
- NSW Agency for Clinical Innovation: NSW Stroke Reperfusion Service
- Read about how the Sax Institute and the ACI are working together through the Hospital Alliance for Research Collaboration and two major implementation research projects
- This blog post first appeared on Web CIPHER, a website community for health decision makers managed by the Sax Institute. Learn more about CIPHER here.