Hi, welcome to the Regional Time-Sensitive Care Coalitions course presented by the American College of Cardiology. I'm Mick Gunderson, and I'll be guiding you through these lessons. This first one provides a course overview and the business case for creating a Regional Time-Sensitive Care Coalition, or RETSCO, in your community or region. In Lesson 2, we'll talk about the roles and responsibility of the RETSCO, and if the group decides to have one, the role of the RETSCO manager. Lesson 3 will address the issues to consider in determining the RETSCO's catchment area and which organizations to include. Lesson 4 talks about making a preliminary assessment of time-sensitive care within the catchment area. Lesson 5 goes on to discuss how to organize a meeting of stakeholders to consider creating the RETSCO. Lesson 6, then, is actually about conducting the stakeholder meetings, and we'll also talk about ways to sustainably fund the RETSCO. Lesson 7 covers the meetings of the condition-specific committees, and Lesson 8 talks about ways to establish transparency and accountability, and we then wrap up the course with a few thoughts on celebrating the efforts of RETSCO Improvement Project Teams, the various committees, and the RETSCO overall. It should be noted that this course has been designed to supplement the Regional Time-Sensitive Care Coalitions Toolkit, which can be found at cdquality.acc.org slash systemsofcare. Upon completion of this course, you should be able to describe the rationale for Regional Time-Sensitive Care Coalitions that address multiple conditions, be able to recognize the steps in determining a catchment area and conducting a preliminary assessment of time-sensitive care within that catchment area, recall the steps in preparing and conducting a meeting to consider establishing a Regional Time-Sensitive Care Coalition, and utilize the ACC Toolkit for time-sensitive care coalitions. All of this will help you better utilize the ACC's Toolkit to assist in the implementation of a time-sensitive care coalition in your region. As you work your way through the lessons in this course, please feel free to ask questions and make comments by sending them to ncdrmail at acc.org. They'll be routed from there to the right people to get you answers and respond to your comments. So when we're talking about systems of care for time-sensitive conditions, let's be clear, we're referring to diagnoses like STEMI, out-of-hospital cardiac arrest and stroke, and systems of care are needed for each of these conditions in order to get the best outcomes. These systems need to guide and coordinate the efforts of patients and bystanders, 911 centers, non-transport medical first responders, ambulances, emergency departments, specialty care teams, rehabilitation centers, and those who provide secondary prevention services. And like the gears of a clock, all of the interactions between these parts in a system of care need to be carefully planned out so that the processes within the system help minimize delays, comply with the latest guidelines, and maximize efficiencies to get the best possible clinical outcomes at the lowest possible system cost. But make no mistake about it, the choreography of coordinating efforts between all of the participants along the continuum of a system of care can require considerable effort and resources to effectively establish and maintain over the long term. This is where having regular systems of care quality improvement meetings with representatives of the health care providers and other stakeholders can yield some significant benefits. This course and the toolkit is intended to help inform and support the efforts to set up a group for those meetings and make their efforts to improve their systems of care as successful as possible. Keep in mind that in every community or region there is a system of care of some sort for each time-sensitive condition, but quite often these systems of care have not been formally conceived or designed, particularly across entire regions with the input of multiple hospitals and EMS providers. They usually develop very organically over time, and as a result, when those systems have not been carefully considered and proactively designed, the resulting processes used to deliver services and manage the often complex logistics can end up being quite inconsistent and inefficient, resulting in less than optimal outcomes and wasting time and resources along the way. It's also important to realize that there is huge diversity in the way emergency services are organized across the country. There are multiple EMS delivery models, hospital capabilities, and competitive hospital networks. These local circumstances will need to be factored into a systems of care program by tailoring the implementation of a RETSCO to a particular city, county, region, or state. There may be little impetus for system development, so efforts to formally establish a systems of care program may be met with apathy or resistance. And these are some of the challenges that a champion for establishing a RETSCO should be prepared for. Now, historically, champions from hospitals and EMS provider agencies have usually taken the lead for establishing more formally designed systems of care for the various time-sensitive conditions, but that doesn't always happen in every community or region, and unfortunately, there usually isn't an entity with clear system-level responsibility that takes this sort of issue on or is there to work with a champion to address the often difficult tasks of bringing together rival hospitals, EMS providers, physician specialty practice groups, payers, and other key stakeholders to tackle the often contentious issues in systems of care development. So without a designated entity to address system-level issues in time-sensitive care, there usually isn't a mechanism in place to measure the performance of the system of care apart from raw outcomes. There usually isn't a way to assess the various processes of care across the continuum for lack of data sharing to facilitate systems-level measurements. And without such measures, communities and regions may not have any idea how well the systems of care in their community are actually functioning. But despite these obstacles, there are some communities and regions that have high-performing systems of care. Their systems have been carefully considered, thoughtfully and proactively designed, and have been well-managed over the long term. They consistently achieve top-ranking outcomes and utilize time and resources with great efficiency. And many of the best and most mature examples of such systems of care are found for major trauma and STEMI. While each of the many time-sensitive conditions certainly have their own unique characteristics and issues, they all have lots of issues and elements in common, like emergency inter-hospital transfers, data collection processes, hospital designation issues, ambulance destination protocols, public education programs, dispatcher-guided pre-EMS arrival instructions, accreditations, clinical registries, and all of the data aggregation challenges between an EMS provider and a hospital on a single episode of care, in addition to the data aggregation across multiple patients, aggregation across multiple hospitals, and aggregation across multiple types of provider organizations across entire regions. Yet, in spite of all these commonalities, there has been a strong tendency for even formally established systems of care for these different conditions to work in silos. Patients in the trauma system meet separately from those in the STEMI system, separate from the stroke system, and so on. This is not making the best use of everyone's time and resources. These silos miss valuable opportunities for collaborating on issues they have in common, for cross-pollination of ideas, and for sharing best practices between the time-sensitive condition groups. For example, the trauma community has been refining their formally established systems of care for decades. Might there be something for cardiology to learn for STEMI systems from the surgical community's decades of trauma systems experience? Cardiology started formally establishing STEMI systems of care a little over a decade ago, with fresh eyes and perspectives. Is there anything that the trauma community might learn from cardiology? Stroke is a bit newer to the systems of care arena, and sepsis is starting to gain more traction. Do they have anything to learn from the other systems of care? Might they bring in some new ideas and perspectives to share as well? None of that can happen when they're all continuing to meet in their separate silos. For all of these reasons and more, the ACC and several of its organizational partners in the public health and time-sensitive care arena have been rethinking the way systems of care are established, organized, operated, and improved. This led to the creation of a new systems of care model, one that can encompass all of the time-sensitive conditions and reaches across multiple hospitals and EMS agencies, along with other key stakeholders throughout a given community or region. In this new model, every community or region would have its own high-performing systems of care group that addresses all of the time-sensitive conditions. Instead of having the various systems of care efforts operating in silos, there is a single regional time-sensitive care coalition, or RETSCO. The organizational structure for the RETSCO has the flexibility to address issues in common between time-sensitive conditions collaboratively, while preserving the ability to tackle condition-specific issues separately. This goal can be achieved by establishing a multi-condition stakeholders committee complemented by a set of condition-specific committees. The RETSCO is envisioned to be managed through collaboration and consensus between the various stakeholders. They establish systems-level processes for all time-sensitive conditions regarding operations, quality improvement, governance, sustainable funding, data sharing, reporting, transparency, and accountability. And while the RETSCO model was designed to support systems of care development and operations for multiple conditions, it could also be used with minor modification for single-condition initiatives like a regional STEMI system of care group. So that wraps it up for Lesson 1. Again, please feel free to ask questions and make comments by sending them to ncdrmail at acc.org. I'll see you in the next lesson.

Regional Time-Sensitive Care Coalitions

time-sensitive care

well-coordinated systems of care

STEMI

establishing RETSCO