Kris Gagliardi

Kris Gagliardi
National Patient Pathways Manager – St John

Biography

Kris is a practising Intensive Care Paramedic for St John New Zealand with an interest in clinical pathways and systems of care. His current role is National Patient Pathways Manager for St John, where he is responsible for leading the development of pre-hospital pathways for high-acuity conditions including STEMI, acute stroke and major trauma. He is also responsible for implementing low acuity pathways for ambulance patients in partnership with District Health Boards (DHBs) and Primary Health Organisations (PHOs) including falls prevention, smoking cessation, mental health, social support and other pathways depending on community needs. Prior to becoming the National Patient Pathways Manager for St John Kris was the pre-hospital lead for the Nelson Marlborough STEMI Pathway, New Zealand’s first comprehensive pre-hospital STEMI pathway involving pre-hospital fibrinolysis and direct transport of eligible patients to a PCI capable hospital. Kris is a trustee of the New Zealand Paramedic Education and Research Charitable Trust.

The New Zealand Out-of-Hospital STEMI Pathway – why do we need it?

Co- Presenter:  Dr Tammy Pegg

Background: Although timely reperfusion therapy is instrumental in determining outcomes for patients with ST-elevation myocardial infarction (STEMI), the lack of a coordinated approach in regional New Zealand leads to substantial delays in the delivery of time critical treatment.
Methods: A collaborative treatment pathway involving St John and secondary care aiming to deliver either Primary Percutaneous Coronary Intervention (PPCI) or pre-hospital fibrinolysis with routine immediate transfer of eligible patients to a PCI centre was developed, trialled and evaluated in the predominantly rural Nelson and Marlborough region of New Zealand. Using data from ANZACS-QI and St John ePRF data; parameters including pre-hospital ECG transmission, fibrinolysis administration, device and transfer times were evaluated.
Results: Sixty-seven of the 100 consecutive patients with STEMI/presumed STEMI from February 2016 onwards met the eligibility criteria; the initial reperfusion strategy included PPCI (n=35), fibrinolysis (n=31), and medical treatment (n=1). First medical contact (FMC) to device time for PPCI patients was 81 mins (43-194, n=34, 76.5%<120 mins), FMC to pre-hospital needle time was 44 mins (16-78, n=21, 23.8%<30 minutes). First medical contact to arrival at a PCI centre was 75 mins (27-278, n=54, 66%<90 minutes), however door in door out time (DIDO) time for patients presenting to a non-PCI centre was 99 mins (25-248, n=9, 11.10%<30 mins).
Conclusion: A coordinated STEMI pathway can lead to timely arrival at PCI centres and reperfusion therapy for patients that receive PPCI and reasonable FMC to pre-hospital fibrinolysis times. However, poor DIDO times from non-PCI centres require further improvement to achieve equity.