By Andrea V. Hernandez
Columbus Ledger-Enquirer (Georgia)
Copyright 2006 Columbus Ledger-Enquirer
Distributed by McClatchy-Tribune Business News
For heart attack victims, every minute before receiving treatment is crucial. And for the EMS workers and hospital staff who interact with those victims, every minute counts as well. Whether its transporting patients to the hospital or preparing for needed surgery, time is of the essence. Currently, hospitals hoping to meet the national standard must be able to open blocked arteries leading to the heart in 90 minutes or less from the time the patient arrives at the hospital’s emergency room. But according to the D2B Alliance — a national network of hospitals, physicians and other partners working to reduce door-to-balloon times — only 40 percent of hospitals have been able to meet the standard set by the American College of Cardiology.
In Columbus, St. Francis Hospital is making sure its door-to-balloon times are beating the standard, and putting each minute to good use.
From the time a heart attack victim arrives in the emergency room to the time the patient’s artery is opened up by balloon angioplasty, it takes St. Francis a median of 83.5 minutes, according to St. Francis data from July and August 2006.
“I’m particularly proud of our results,” said Deborah Saylor, senior vice president of patient care services. “We’re continually looking at ways to constantly improve those numbers because treating heart attacks and using the door-to-dilation data can help prevent what formerly always resulted in permanent damage.”
Studies have shown strong associations between door-to-balloon times and in-hospital mortality risk, according to the D2B Alliance.
“Any time that we reduce can save heart muscle,” Saylor said.
400,000 cases annually
According to the alliance, each year almost 400,000 patients are admitted to U.S. hospitals with heart attacks, usually involving blocked arteries that lead to the heart. Blockage may cause blood supply to slow or stop, preventing needed oxygen and nutrients to the organ. As a result, part of the heart tissue is affected and may die.
A large number of hospitals are using percutaneous coronary intervention, or PCI, methods. These methods are one of the most effective and preferred ways to open up blocked vessels and get blood flowing into the heart again, according to the U.S. Department of Health and Human Services. PCI involves a catheter, or flexible tube, that is inserted and pushed through blood vessels to the blocked area. These interventions include angioplasties, stenting and atherectomies.
With an angioplasty, a balloon is inflated to open the blood vessel. Stents are small wire tubes, and they are placed in the vessel to hold it open. With an atherectomy, the blockage is cut and removed via blade or laser.
St. Francis is the only hospital in the Columbus MSA that performs angioplasties. If a heart attack victim is brought to facilities other than St. Francis via ambulance — simply because of the severity of the attack and the proximity of a facility — the patient is stabilized then moved to St. Francis, local hospitals and paramedics said.
Collaborative effort
Saylor said its the “three-part level of cooperation” at St. Francis that helps them stay under the the 90-minute mark.
The first of the three groups, EMS workers, notify the hospital when they are on the way to the hospital. They can start treatment by giving certain medications.
Once the patient arrives at the hospital, the individual is sent to the emergency room while the catheterization laboratory prepares to receive the patient. The lab team of nurses then move the patient up to the lab, where cardiologists perform the angioplasty. St. Francis has 12 cardiologists on staff.
“It really is communication and cooperation within all three of those entities,” Saylor said.
Later, cardiologists and staff review the data from each heart attack case, one by one. They also share their results with the American College of Cardiology.