Ruth Cantu, BSN, RN, Accreditation Review Specialist, Society of Cardiovascular Patient Care
In March 2011, the Society of Cardiovascular Patient Care (SCPC), formerly the Society of Chest Pain Centers, was approached by an Army officer from a US Military Treatment Facility (MTF) interested in learning more about implementing SCPC accreditation. Because military facilities have longstanding experience as accredited hospitals, the goal was to focus on becoming accredited in the care of the acute coronary syndrome (ACS) patient.
SCPC has worked with civilian facilities to make their processes of care smarter and more efficient for years. Serving more than 800 civilian hospitals worldwide, SCPC felt it was the right time to expand the program offering to the military. Although conversations revealed that the military differed from the civilian world, it was noted that processes could be adapted and streamlined for the ACS patient to gain greater efficiencies of care in the MTFs.
Many MTFs transfer their patients to civilian facilities capable of providing interventional services to achieve reperfusion. An advantage of those relationships was that many of these patients were being transported to SCPC-accredited facilities, with MTF patients thereby benefitting from improved processes once they reached the accredited chest pain centers. However, issues related to the delays in initial MTF care processes were identified.
After several discussions and extensive research into the unique environment and challenges presented by the MTFs, several questions were raised:
* Could SCPC find a way for military hospitals to become an accredited chest pain center within the guidelines and requirements of the Department of Defense?
* Would it be possible to adapt SCPC’s current accreditation criteria and processes to accomplish MTF accreditation?
Another challenge was the overriding concept of “force protection.” Federal policies are in place to ensure that military bases/posts/installations are secured and protected at all times, which would mandate a change in the way that SCPC structures aspects of the accreditation criteria and the site review process. Ultimately, it was determined that these aspects could be modified while still maintaining current accreditation requirements, so MTFs could establish standardized processes and pathways to capture the uniqueness of these changing environments and personnel.
As research continued into how SCPC could impact and continue to understand military culture, it became clear that the goals for the Military Health System were no different from that of civilian hospitals. In 2011, the Surgeon General for the Army announced his top initiatives for Army medicine, of which one goal was to improve the “Culture of Trust” with the “aim to reduce variance, standardize, and improve patients’ healthcare experiences….” The 2012 mission for the Military Health System presented a “Quadruple Aim” to address 4 areas, and SCPC could impact 3 of the 4 as follows:
* Population health—“encouraging healthy behaviors and decreasing the likelihood of illness through focused prevention…”
* Experience of care—“care that is patient and family centered, compassionate, convenient, equitable, safe, and always of the highest quality…”
* Per capita cost—“creating value by focusing on quality, eliminating waste, and reducing unwarranted variation; considering the total cost of care over time, not just the cost of an individual health care activity…”
SCPC recognizes the unique challenges for the MTF and believes that service members should have access to care that meets national guidelines and standards. SCPC’s program, which has been validated to improve care, was adapted for the MTF, taking into consideration military regulations and force protection protocols. Through collaboration within SCPC and the military points of contacts, a modified version of the SCPC accreditation criteria was produced, tailoring the criteria to the unique needs of the MTF to target all the initiatives set forth.
Operation STEMI Care (OSC) became an SCPC version of a special operation. It was launched on Veterans Day 2012, with the overarching goal being to ensure that SCPC’s MTF accreditation process is mission driven and ensures operational standardization and consistency in an environment with significant fluctuations in personnel. By implementing this program, SCPC has expanded the world’s best hospital process improvement experience to reach an estimated 9 million active, retired, and dependent beneficiaries.1
Statistics show military personnel have unique needs:
* Military personnel with symptoms of posttraumatic stress disorder are at greater risk of heart attack.2
* The risk is 18% higher with age, even after accounting for known heart disease risk factors.
* These individuals are twice as likely to die from heart disease as those without posttraumatic stress disorder.
OSC will focus on a cross-disciplinary approach and advocate for breaking down “silos” that bridge EMS (local and bases/posts/installations), emergency medicine, cardiology, nursing, laboratory, and all MTF personnel, both clinical and nonclinical. OSC will impact all who are involved in the care of the ACS patient while also encouraging community outreach.
SCPC is a mission-driven, patient-centric, nonprofit process improvement organization founded in science and validated by accreditation and certification.
* Evidence-based processes
* Improved quality outcomes
* Greater cost efficiency
* Higher patient satisfaction
* Defined pathways to reduce missed heart attacks
* Consistent approaches to risk stratification
* Improved performance on quality indicators
SCPC has always focused on reducing cardiovascular mortality and morbidity through the promotion of contemporary, evidence-based medicine and the adoption of process improvement science by healthcare providers. Achieving this for a population with such special considerations was untested, until SCPC’s beta sites (Army and Navy) began reporting significant improvements in multiple areas. These areas included:
* Prompt identification and recognition of signs and symptoms for ACS patients, specifically those with acute myocardial infarctions
* Improved communication leading to reduced transport times
* Establishment and maintenance of efficient processes of care, along with focused and targeted education
* Data collection
* Improvement across the continuum of overall care
Servicemen and women understand risk. OSC reduces risk and increases understanding of how to get better processes across the military healthcare family. For OSC, SCPC expands upon its original motto “Because every heart matters” to target our servicemen and women directly: “Because every heart matters and because no one deserves better care.” In this small way, SCPC hopes it can now serve those who serve us.