Through a collaborative approach, Interior Health physicians are leading the work to improve care for STEMI patients, to whom timely access to care is life-saving.
In this article, we illuminate the work of two physicians: Dr Suman Dhesi and Dr Anders Ganstal. They are making strides in STEMI care in different ways through Physician Quality Improvement (PQI) initiative.
PQI Cohort 1: Prehospital Thrombolysis Collaborative Heart Attack Management Program (CHAMP)
Although percutaneous coronary intervention (PCI) is the best possible care for STEMI patients, the vast geographical distance of Canada prolongs the patient transportation time to PCI centres. It is no different in the Interior Health region—a large geographic area of over 215,000 square kilometres. The Collaborative Heart Attack Management Program (CHAMP) was born to overcome this barrier by reducing time to treatment through enhancing prehospital diagnosis and bringing care closer to patients.
The Prehospital Thrombolysis CHAMP was spearheaded by Dr Suman Dhesi, a Cardiologist at Royal Inland Hospital (RIH) in Kamloops. Supported by the Interior Health PQI team, the project aimed to have advanced care paramedics (ACPs) recognize and manage heart attacks in the field by administering thrombolytics to appropriately selected patients after consultation with the on-call Cardiologist at RIH.
This work represented a unique collaboration between Interior Health and BC Emergency Health Services (BCEHS) and involved physician partners, pharmacists, medical students, paramedics, ER physicians, patient partners and many more. Dr Dhesi and her team made presentations to multiple forums including the BC Patient Safety and Quality Council conference, consulted with world experts, and created a toolkit and comprehensive protocol to minimize medical errors. The team was able to reduce the median time from first medical contact (FMC) to thrombolysis by 70% through this project. These outcomes led to a British Medical Journal (BMJ) article: Collaborative Heart Attack Management Program (CHAMP): use of prehospital thrombolytics to improve timeliness of STEMI management in British Columbia.
From PQI Cohort 1 to PQI Cohort 4
Dr Anders Ganstal is an emergency physician at RIH, who also works as the Regional Medical Director for BC Emergency Health Services (BCEHS) Interior. Dr Ganstal, in a supporting role to Dr Dhesi’s Prehospital Thrombolysis CHAMP project, was fascinated by the QI framework and its impact on change initiatives. He was inspired to join PQI as a Cohort 4 participant to enhance STEMI care from the dual lens of both an emergency physician and the Regional Medical Director for BCEHS Interior.
PQI Cohort 4: Primary Care Paramedics (PCP) CHAMP
PQI Cohort 4 was the start of the dyadic leadership between Dr Ganstal and Jonathan Deakin, Paramedic Practice Leader, BCEHS.
Dr Ganstal recalls: “The dyad formed because Jonathan and I were in the same BCEHS portfolio and grew because we understood how each other worked.” With the combined knowledge of emergency medicine, prehospital medicine and organizational operations, they identified an opportunity to improve care for STEMI patients in close proximity to PCI centres.
The dyad developed and deployed a Primary Care Paramedics (PCP) training program called PCP CHAMP, with support from diverse stakeholder groups.
In partnership with Interior Health teams (Simulation, Pharmacy and PQI consultants), BCEHS paramedics, medical students, and more, Dr Ganstal and Jonathan provided real-life scenarios through training for the interdisciplinary team members. They also received support from partner foundations3 to purchase expanded cardiac monitoring in ambulances.
These partnerships have enabled PCPs to acquire prehospital electrocardiograms (ECGs), transmit the data to the emergency physician for their medical oversight, and bypass local hospitals and transport the patient directly to a PCI centre.
Supporting foundations include Kelowna General Hospital (KGH) Foundation, Vernon Jubilee Hospital (VJH) Foundation, and South Okanagan Similkameen (SOS) Medical Foundation
Data-Driven Quality Improvement
In addition to collaboration, a focus on data is another key ingredient of the PCP CHAMP project.
Dr Ganstal and Jonathan worked with Lee Roberts, Paramedic Practice QI Coordinator with a specialty in clinical performance, to generate the prehospital STEMI dashboard. This tool tracks critical data for PCP CHAMP STEMI Care cases. They also made sure to track Prehospital Fibrinolytic STEMI cases in the dashboard to support the Prehospital Thrombolysis CHAMP project led by Dr Dhesi. The dashboard rapidly presents performance data, allowing for improvements based on statistics and accurate outcomes reporting.
Quantitative data is used for regular PDSA cycles and reviewed by a collaborative team, which includes a patient partner.
Between July 2021 and July 2022, 31 PCP CHAMP applicable STEMI cases have employed the STEMI Bypass Protocol in Interior Health. This means that 31 patients were directly transferred to Kelowna General Hospital, bypassing local sites and received PCI—the best possible care.
“I believe they saved my life,” a PCP CHAMP patient shared their experience in an interview.
Collaborate, Scale-Up and Spread
Dr Ganstal and Jonathan’s journey to improve STEMI care did not stop after PQI Cohort 4 Graduation in June 2022. They continue to work with Interior Health stakeholders for PCP CHAMP, where there is a STEMI pathway. They also continue to support the Prehospital Thrombolysis CHAMP led by Dr Dhesi in areas without STEMI pathway.
The Prehospital Thrombolysis CHAMP, in collaboration with the BC STEMI Working Group and Cardiac Services BC, is set to scale up to Nanaimo (Island Health) and Prince George (Northern Health) in Fall 2022. The collaborative journey started in Interior Health PQI is now scaling up and spreading–bringing care closer to patients and saving lives in critical moments.
Dr Anders Ganstal
PQI is a flagship initiative of the Specialist Services Committee, a partnership of Doctors of BC and the Ministry of Health. In collaboration with BC health authorities, PQI works to enhance physician capacity by providing training and hands-on experience on quality improvement projects, ultimately promoting a culture of learning, openness and dedication to quality improvement in health care system.