A PROVINCIAL REGISTRY TO FACILITATE QUALITY IMPROVEMENT RELATED TO DOOR TO NEEDLE TIME IN NOVA SCOTIA

Cardiovascular Health Nova Scotia (CVHNS) is a corporate-wide program of the Nova Scotia Health Authority, responsible for monitoring, surveillance and actioning targeted quality improvement initiatives related to cardiovascular disease and stroke. The CVHNS Cardiovascular Registry contains comprehensive data on all admissions for acute myocardial infarction, unstable angina and heart failure dating back to October 1997; however, retrospective collection inhibits timely access to data for the purposes of quality improvement. Improving door to needle time for ST elevation MI (STEMI) is a priority throughout Nova Scotia, as fibrinolysis remains the initial treatment for half of STEMI, with only 1PCI centre. Data have been collected locally since 2006 by most CVHNS Cardiovascular Coordinators in the province, using a variety of methods and rules. To mitigate the challenge of timely access to data, we undertook the development of a standardized database and processes. An indicator generating process was included for ease of monitoring the impact of local process changes, while providing more timely information on the province’s performance as a whole. A draft set of fields (form) was selected from current collected data (retrospective). This was reviewed with 2 of the Cardiovascular Coordinators for feasibility (e.g., availability in documentation, etc.) and necessity for generating indicators, as well as consistency with current local collection. Revisions were made and the form was generated in the CVHNS Registry, pilot tested by the 2 Cardiovascular Coordinators and subsequently revised. Processes for data collection were standardized and a report written to generate key performance indicators suitable for monitoring/evaluating the impact of local process changes, while also providing more timely information on the province’s performance as a whole. The database went live in December 2017. Data have been collected in near real time for all fibrinolysis cases since January 2018, with cases being identified primarily from pharmacy drug dispensing systems. Cases who did not receive fibrinolysis are obtained quarterly from the Discharge Abstract Database using codes I210, I211, I212 and I213. In 2018, information was captured on 347 fibrinolysis cases, which is consistent with numbers from the long term retrospective database. Local data collection in close to real time is feasible. Our next steps are to compare the accuracy of the data to explore whether it can be used to replace the same information currently collected retrospectively. A timely method of identifying STEMI who did not receive fibrinolysis remains a challenge.