Accreditation: Operation STEMI Care: An Update
By Ruth Cantu, BSN, RN, AACC, and Robyn Keller MSN, RN, AACC
Operation STEMI Care is an accreditation program launched in 2012 by the Society of Cardiovascular Patient Care, now ACC Accreditation Services, specifically for U.S. military treatment facilities interested in becoming accredited in the care of acute coronary syndrome (ACS) patients. Although military treatment facilities differ greatly from civilian facilities, the needs and goals are the same: to provide quality care for ACS patients through improved patient outcomes and lower mortality rates.
Since the implementation of the program, one military treatment facility has worked within the confines of federal policies to achieve accreditation. Among its accomplishments, the site improved its rate of “door to reperfusion within 90 minutes,” achieving the goal of 75 percent compliance over the course of the accreditation process; as required, tracking of this benchmark has continued post accreditation.
Additionally, the site demonstrated its capacity for prompt identification and recognition of signs and symptoms of ACS patients, specifically those with acute myocardial infarctions or STEMI; improved communication leading to reduced transport times; establishment and maintenance of efficient processes of care along with focused and targeted education; data collection; and improvement across the continuum of overall ACS care including observation services.
In 2014, the Department of Defense and the Military Health System issued a report comparing performance in military treatment facilities with the care purchased from civilian providers. The report indicated there was better performance from civilian hospitals, with military treatment facilities in some areas falling below national and Department benchmarks. As a result of this review, the military health system was directed to take action with regard to “…quality, access, patient safety, transparency, and patient commitment.”
Operation STEMI Care offers an opportunity to address several of these areas, by providing across-disciplinary approach intended to bridge emergency medical services (local and bases, posts and installations), emergency medicine, cardiology, nursing, laboratory, and all military treatment facility personnel, both clinical and non-clinical. Since its inception, the program has underscored the need for standardization and streamlined care process for the ACS patient across military treatment facilities, including adoption of quality indicators for all military treatment facilities.
The implementation and adoption of established registries, such as the ACC’s CathPCI Registry and ACTION Registry-GWTG, along with the accreditation process overview and Accreditation Conformance Database, can facilitate the tracking of system-wide metrics and the more timely provision of information that can be used to evaluate process improvement areas and create benchmarks to improve mortality rates and patient outcomes.
Recognizing the unique challenges for the military treatment facilities to achieve accreditation, efforts are now targeted at ensuring a method for all military treatment facilities to capture data with less variation in performance and at providing transparency in the adherence to national benchmarks in the overall care of ACS patients.
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