RACE Reperfusion of Acute Myocardial Infarction in Carolina Emergency Departments The Reperfusion of Acute Myocardial Infarction in Carolina Emergency Departments (RACE) project is a collaborative effort to increase the rate and speed of coronary reperfusion through systemic changes in emergency care. The project is based upon the collaborative efforts of EMS personnel, physicians, nurses, administrators, and payers from five regions and 68 hospitals throughout North Carolina. The recommendations of this project are based upon established guidelines, published data, and the knowledge and experience of numerous individuals specializing acute myocardial infarction care. RACE Fall 2009 Update The RACE ER project recently completed 6 regional blitz meetings across the state that was attended by 300 participants representing EMS, Non PCI, and PCI systems. The overall program goal was for participants to return to their system with the ability to refine interventions to meet the project goals. The agenda topics allowed for participants to discuss regional issues and strategies to improve the timeliness of treatment for their STEMI patients. Inspirational success stores of STEMI patients were shared across the state. Additional topics included the review of the updated RACE manual (this may be downloaded from www.race-er.org), the future of the RACE project, and Mission: Lifeline�s exciting move towards recognition for systems involved in STEMI care. With the anticipation of the final quarter of data, the meeting concluded with a challenge from the RACE central team, Drs Granger and Jollis, co-investigators, Lisa Monk RN, MSN, State Project Leader, and Mayme Lou Roettig RN, MSN, Executive Director and Mission Lifeline consultant, to implement the �Top 10 To Do List� and call to action to make NC the safest place to have a heart attack. RACE Update Summer 2008 The success of RACE has been based on the efforts and contributions of hundreds of health care professionals across the state of North Carolina. For the initial project, state level cardiology leadership has included Yele Aluko, Bob Applegate, Joe Babb, Dave Bohle, Bruce Brodie, Paul Colavita, Chris Granger, Bill Hathaway, Jamie Jollis, Bill Maddox, Tom Stuckey, Scott Valeri, and Hadley Wilson. The partnership between our cardiology community and key emergency medicine physicians, nursing leadership through the RACE coordinators and emergency department nurse managers, quality assurance colleagues, and CV administration was critical to the project. The results of the initial RACE project were published in the Journal of the American Medical Association in November 2007, demonstrating substantial improvements in all treatment times across the state (please see power point labeled Final RACE Results for detail). The RACE project was named one of the top 10 advances in heart disease by the American Heart Association, and the North Carolina model is being adopted by other state Chapters. With the continued support of ACC members and councillors across the state, the Reperfusion in Acute Myocardial Infarction in Carolina Emergency Departments (RACE) project has developed into the leading state-wide system in the United States. The American Heart Association (AHA) has recently launched an initiative - Mission: Lifeline™- which focuses on the entire STEMI system of care from point of entry into the healthcare system to reperfusion and back to the local community for follow up. The RACE model was one of the models used in construct of Mission: Lifeline. The next phase of RACE has an expanded acronym, RACE- ER (Emergency Response) and will invite voluntary participation of all acute care emergency departments and emergency medical services (EMS) serving North Carolina to work together in this continued quality improvement project of the North Carolina Chapter of the ACC and in partnership with the AHA initiative- Mission: Lifeline. The objectives for RACE-ER will be providing timely coronary reperfusion for all eligible STEMI patients. To date, 5 regions spanning the entire state have been organized (Coastal Plains, Triangle, Triad, Charlotte- Metro, and Western NC). Within each region, integrated STEMI treatment plans have been and are continuing to be implemented by teams of physicians, nurses, technicians, administrators, and public officials at hospitals and emergency medical service agency level. Similar to the trauma system, the emergency medical service, emergency departments, critical care transport, and cardiac catheterization laboratories work in a concerted and urgent fashion to rapidly diagnose and most effectively open occluded coronary arteries. In order to support these efforts in the most impoverished regions in the state (tier 1 and tier 2 counties and critical access hospitals), the Kate B. Reynolds Foundation has provided a 2 year $400,000 grant. Through the hospitals and emergency medical services participating in RACE, we will attempt to further improve our rate and speed of coronary reperfusion, with a particular focus on the emergency medical service aspect of STEMI care. North Carolina has over 800 emergency medical service agencies, many of which are challenged in covering large rural regions and obtaining the necessary equipment and training to diagnose STEMI. The RACE project provides an important opportunity to provide training and support to the emergency medical technicians and emergency department personnel on the front lines of cardiac care. All 21 primary interventional facilities (see NC RACE PCI Hospital list for key contact) that provide 24/7 emergency PCI STEMI care have come to consensus on criteria to participate and serve as many North Carolinians with the preferred reperfusion therapy of primary percutaneous coronary intervention (PCI). The most recent meeting is recorded in attached pdf from May 15, 2008. Optimal System Specification by Point of Care Operations Manual 2008 Download PDF RACE 2005-2007 The RACE project is a collaborative effort to increase the rate and speed of coronary reperfusion through systemic changes in emergency care. The project is based upon the collaborative efforts of EMS personnel, physicians, nurses, administrators, and payers from five regions and 68 hospitals throughout North Carolina. The recommendations of this project are based upon established guidelines, published data, and the knowledge and experience of numerous individuals specializing acute myocardial infarction care. Key collaborators in this project include the councilors of the NC Chapter, and in particular Drs. Colavita, Babb, Bohle, and Hathaway; Dr. James Jollis who is co-director of the project; Mayme Lou Roettig who is executive director; and cardiology and emergency care leaders from the five regions. Over the two years of the program, physicians collected information on 2,000 patients, measuring pre and post-intervention times for key processes: the time from when the patient arrives at the hospital door to either angioplasty or clot-busting therapy, and the time it takes for a patient at a feeder hospital to enter and leave the transferring hospital, and the time a patient enters a feeder hospital to treatment at a second, receiving hospital. Times improved substantially in all areas. Median time from door to treatment for hospitals offering angioplasty fell from 85 to 74 minutes. (22 percent) Median time from door to infusion of clot-busting therapy fell from from 35 to 29 minutes. (17 per cent) Median time from door-in to door-out at transfer hospitals fell from 120 to 71 minutes. (41 per cent) Median time from arriving at a feeder hospital to beginning treatment at a receiving hospital fell from 149 minutes to 106 minutes. (29 per cent) RACE AHA Final Results View the AP story that also appeared in the Philadelphia Inquirer, NY Times and more than 400 other news outlets. View the FOX News story. RACE Poster - Download PDF RACE Referring Hospitals Data Collection Form- Download PDF News Release For Immediate Release, November 1, 2005 Contact: BCBSNC, Rita Simonetta Duke University Medical Center, Richard Merritt Blue Cross and Blue Shield of North Carolina and Statewide Health Care Consortium Team Up to Win the Race Against Heart Attacks. Duke Medical Center founded initiative to improve care for heart attack patients in North Carolina emergency rooms. A consortium of North Carolina health care providers and Blue Cross and Blue Shield of North Carolina (BCBSNC) today announced details of a collaborative project to improve the survival rate of patients rushed to the hospital with heart attacks. The consortium, which includes physicians, hospitals and emergency medical services professionals, is launching a new effort called Reperfusion of Acute MI in Carolina Emergency departments (RACE). RACE is the most extensive effort in the nation to improve care of heart attack patients by organizing ambulances, emergency departments and hospitals to provide the best treatments, said Duke University Medical Center cardiologist and RACE co-medical director Christopher Granger, M.D. In North Carolina, it gives us the opportunity to do a much better job treating heart attacks to improve survival. The issue is especially important in North Carolina, team members said, since national registries have shown that only about 60 percent of North Carolinians who come to an emergency room receive potentially life-saving reperfusion therapies for a myocardial infarction (MI), or heart attack, compared to the national average of at least 70 percent. The RACE project could also serve as a national model for collaborative efforts to improve the delivery of emergency care. The North Carolina consortium comprises five regions centered in Greenville, Chapel Hill/Durham, Greensboro/Winston-Salem, Charlotte and Asheville. Each region consists of networks of emergency medicine ambulance systems, smaller hospitals and referral hospitals. Other partners in the project include the Duke Clinical Research Institute of Duke University Medical Center and the North Carolina chapter of the American College of Cardiology. This project will help save lives in North Carolina, said Robert Harris, M.D., senior vice president of health care services and chief medical officer for BCBSNC, which is supporting the effort with a $1 million corporate grant. What we are facing in North Carolina is a microcosm of what is happening in the country as a whole we know that world-class medical services and treatments are available, yet we seem to have a problem with timely access and coordination. Unlike some national efforts that attempt to deal with this issue from afar, we are actually in the trenches trying figure out what works the best,said Duke cardiologist and RACE co-medical director James Jollis, M.D. Much time has been spent over the years conducting clinical trials to figure out what works for heart attack patients. Now, we are trying to put into practice what we all know that opening arteries quickly saves lives. We have hit a wall at treating about 60 percent of eligible patients and we're not improving much more, we believe we can do better. Throughout the course of the two-year project, RACE researchers will collect data on heart attack patients; both those who received treatment and those who would have been candidates for reperfusion therapy, but did not receive it. RACE's goal is to provide each facility with feedback to aid streamlining patient evaluation and treatment. Reperfusion therapies involve using either a clot-busting drug or a catheter in an operation called an angioplasty. These therapies unblock clogged coronary arteries, sparing heart muscle from damage due to lack of oxygen. While clot-busting, or thrombolytic, drugs are available at most hospitals and emergency rooms, angioplasty is not as widely available. Angioplasty has been found to be more effective than thrombolytics in reopening arteries when performed within 90 minutes of a patients arrival to the hospital. RACE plans to improve outcomes of heart attack patients by funding educational nursing programs, conducting physician teleconferencing seminars on reperfusion therapies, providing emergency room guideline tools and expanding the use of electrocardiogram (EKG) machines in ambulances, so vital data about patients' hearts can be transmitted ahead to emergency personnel. The program will also analyze health care delivery systems at participating hospitals. While many larger centers have layers of service and personnel that provide round-the-clock care, some smaller hospitals do not treat many heart patients and may not be optimally staffed for emergencies, team members said. The program has established a 24-hour hotline administered by senior cardiologists who can consult with emergency room physicians at smaller hospitals lacking an on-site cardiologist available 24 hours a day. RACE Central Coordination 2400 Pratt St-Room 7005-7th Floor Durham, NC 27705 Co-Medical Directors: Christopher B. Granger, MD christopher.granger@duke.edu James G. Jollis, MD jamie.jollis@duke.edu Executive Director: Mayme Lou Roettig, RN, MSN mayme.roettig@duke.edu State Project Leader: Lisa Monk, RN, MSN lisa.monk@duke.edu RACE PCI List with Key Contacts RACE Sponsors