Stroke & STEMI Implementation

Time Critical Diagnosis System

Missouri’s Time Critical Diagnosis-Stroke and STEMI System

Missouri’s Goal:  To improve health outcomes by expanding the time-critical diagnosis (TCD) system that addresses trauma to include care for Missourians who experience a stroke or ST-segment elevation myocardial infarction (STEMI). 

Problem:  When a Missouri resident suffers a stroke or STEMI (a potentially fatal type of heart attack), their survival and recovery directly depends on the time it takes for them to receive definitive treatment.  There are many variables that impact treatment and care. Missouri has begun to improve its statewide system to assure the right care, at the right place in the right time for those who suffer a stroke or STEMI.

Approach:  Emergency medical care providers recently invested extensive time and effort to craft recommendations to establish a functional TCD system in Missouri to improve the transport, diagnosis and treatment for stroke and STEMI patients.  The TCD system integrates these two time critical diagnoses with the established trauma care model. 

HB 1790 passed in 2008 provides authority to DHSS to promulgate rules and regulations for stroke and STEMI centers.  DHSS has convened an advisory body and work groups to implement the other recommendations to improve the TCD system.

See the attached Implementation Overview 2008-2010 for details on plans for the TCD system development to support stroke and STEMI care.

TCD-Stroke and STEMI System Advisory Committee
Roles and Responsibilities:

• Advise DHSS on process to implement TCD system, representing respective organization or agency perspective, while supporting systems approach.
• Maintain two-way communications with organization members or agency colleagues to provide updates on TCD system implementation and gather input on best approaches.
• Establish guiding principles for work group discussion and decisions.
• Help resolve problems or issues that may arise from work groups.
• Advise DHSS on administrative approaches for TCD system implementation.

Time Critical Diagnosis (TCD)—Stroke and STEMI System Implementation Advisory Committee Members

TCD-Stroke and STEMI System Implementation Work Groups

General purpose:  DHSS has convened work groups to implement the recommendations in the report compiled by the TCD Task Force: Time Critical Diagnosis System Recommendations to Advance Emergency Medical Care for Stroke and STEMI in Missouri.  Work groups will draft and help finalize the products and complete tasks described in this document.  Appropriate linkages will be made between work groups to assure a coordinated approach between emergency medical care providers.  Stroke and STEMI work groups are addressing the distinctive emergency medical treatment and care issues that each of these conditions require.

Work group division:  While there are unique and distinct issues inherent to stroke and STEMI, there are processes and approaches common to both conditions.  Work groups are completing their tasks with both of these views in mind at each stage of emergency medical care.   Each work group has the following divisions: 

1. Pre-hospital response and transport,
2. Hospital,
3. Rules and regulations,
4. Quality improvement,
5. Professional education, and
6. Public education.

Estimated Time Frames for Work Groups:  DHSS staff estimates that beginning in 2008 it will take two to five years before the core elements are implemented within the TCD system.  The Department projects that work groups will meet through 2009 to address the actions proposed in the report published in 2008.  There will be variance in the amount of time needed by each work group to complete their tasks in view of the unique nature of each groups’ issues, the coordination and staging of tasks required between work groups, and the dynamic environment in which this work will take place. 

See the attached for graphic depicting work groups and a listing of the tasks for each work group: Time Critical Diagnosis-Stroke and STEMI System Implementation Work Groups.

The work groups are using the Guiding Principles and Ground Rules to steer their work.

Meetings

Meetings are scheduled beginning in September 2008 through May 2009.  Attached is the schedule for meetings.

September 30, 2008 Meeting
Meeting Highlights

October 21, 2008 Meeting
Agenda
Meeting Highlights
Stroke and STEMI System Details - Highlights from Other States

December 2, 2008 Meeting
Agenda
Meeting Highlights
STEMI Draft Template
HB 1790

January 6, 2009 Meeting
Agenda
RSVP Form

(Subsequent meeting dates will be added to the webpage when we have the response form and agendas available)

General References

• Recommendations to Advance Emergency Medical Care for Stroke and STEMI in Missouri
• Executive Summary of Recommendations
• General Standards for Trauma Center Designation for the State of Missouri
• TCD Task Force Resource Map
• Secretary of State Office - Regulation
• Regulation Templates: Please note that these documents are merely templates for drafting proposed regulations and have not been officially reviewed or approved.

STROKE

• Definitions and Abbreviations Relating to Stroke Centers
• Standards for Stroke Center Designations
• Stroke Center Designation Requirements

STEMI

• Definitions and Abbreviations Relating to STEMI Centers
• Standards for STEMI Center Designation
• STEMI Center Designation Requirements