Patient Transfer of Care - Performance Measure 1.03

The Tempe fire Medical Rescue Department (TFMR) is an all "hazards" department that responds to all types of calls for service. Transfer times for stroke and heart attacks (S-T Elevation Myocardial Infarction, or STEMI, is a readily identifiable type of heart attack) patients directly impact patient outcomes (chance of full recovery).

Measure

Achieve average times from Tempe Fire Medical Rescue contact with patient to transfer of care to the hospital for stroke incidents of less than 15 minutes and recognition of S-T Elevation Myocardial Infarction heart attack incidents of less than or equal to 5 minutes.

Why this Measure Matters

Through the City Charter, TFMR is the primary provider of emergency medical services (EMS) in the city. Strokes and heart attacks are treatable medical conditions that without timely recognition by EMS providers, can result in death or serious disability. Patient outcomes (chance of full recovery) are greatly improved by faster recognition and transfer of care times when facing these possible life-threatening emergencies. In 2023, TFMR responded to 170 patients who were identified as suffering from a stroke and 107 who were experiencing a STEMI.

The wellbeing of our residents and visitors is very important to TFMR. We are implementing training, ongoing education, and technology solutions with the goal of improving survival rates through correct diagnosis and expedited transfer times to the most appropriate medical facility. These medical facilities are designated as Cardiac Receiving Centers or Stroke Centers. A list of Cardiac Receiving Centers is maintained by the Arizona Department of Health Services. Local Stroke Centers are Banner Desert Medical Center, Dignity Health Chandler Regional Medical Center, HonorHealth Scottsdale Osborn and Steward Tempe St. Luke’s Hospital. 

Information on stroke and heart attacks can be found on the American Heart Association (AHA) website.

Baseline

Transfer of Care for Stroke Incidents: 10 minutes, 52 seconds (CY 2016)
Recognition of S-T Elevation Myocardial Infarction Heart Attack: 10 minutes (CY 2016)

Target

Transfer of Care for Stroke Incidents: Less than 15 minutes by CY 2025
Recognition of S-T Elevation Myocardial Infarction Heart Attack: Less than or equal to 5 minutes by CY 2025

Strategies

1. Training Programs/Hospital Follow Up

• Implement the Visual Disturbance Aphasia and Neglect (VAN) Assessment for all stroke patients per the CAREMSG by December 31, 2024
• Expand the post-incident review programs for continuing education on strokes and heart attacks from 1 local hospital to 5 by July 1, 2025 
• Train (or retrain) all crews on CAREMSG identifying requirement of obtaining a 12-lead Electrocardiogram (EKG) within 5 minutes of patient contact using classroom and hands on scenarios by March 30, 2025
• Offer monthly continuing quality improvement (CQI) to include charts with patients experiencing stroke and heart attacks to field crews in coordination with medical directors by September 30, 2024

2. Technology

• Utilize ImageTrend CQI process to provide feedback to all crews within 72 hours after they treat a stroke or heart attack patient regarding their recognition of STEMI and transfer of care of stroke patient times by July 31, 2024
• Evaluate leasing of Lifepack 35 monitor defibrillators to improve the technology available in recognition of STEMIs by increasing from 12 lead EKGs to 15 lead EKGs by July 31, 2024

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