Because speed is what you need

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Memorial Health System has started a trend — one that’s picking up steam and changing hospital practices for cardiac care across the nation.

The program, known as Cardiac Alert, has reduced the time that patients with symptoms of a severe heart attack wait to receive treatment. The faster patients are treated, the more likely they are to survive and to recover without complications.

According to the National Institutes of Health, Memorial had one of the fastest “door to wire” rates in the nation during 2005-06. About 91 percent of the patients who needed a cardiac catheter procedure, known as percutaneous cardiac intervention or PCI, were treated within two hours.

PCI involves inserting a stent into the coronary artery via a wire threaded through a vein. For patients experiencing an acute myocardial infarction (AMI), it’s important to perform a PCI as soon as possible.

Penrose-St. Frances, using similar procedures, has a “door to wire” rate of 64 percent, lower than the national average of 67 percent, according to NIH figures. The hospital’s rate is a bit better according to statistics from the Department of Health and Human Services, which show Penrose at 74 percent. Memorial’s rate, according to HHS, is 88 percent.

Dr. David Ross, an emergency doctor at Penrose, expressed surprise at the numbers — and was confident that Penrose has made the changes necessary to improve rating.

“From what we get briefed on, I thought the numbers were much closer to 90 or 95 percent,” he said.

Simple program

On its face, the program is simple: paramedics perform an EKG when picking up a patient having a heart attack, start other life-saving procedures and alert the hospital.

Some of the cardiologists and emergency room doctors were skeptical about whether the plan would work, said Memorial nurse Beth Hamstra. But when the very first patient was treated within 45 minutes, everyone got on board.

Dr. Richard Loehr, the head of Memorial’s Emergency Department, said that the changes were made 18 months ago, and that the hospital determined treatment times could not be improved without radically changing the protocol.

Doctors had driven the process, overseeing each patient’s admission and recommending treatment based on their individual preferences.

EKGs were administered after patients arrived at the hospital.

A cardiologist then recommended drugs or surgery.

Delays were built into the system, Loehr said, because each doctor has his or her own drug preferences and treatment protocols.

Patients spent lot of time waiting — for the cardiologist to be contacted, for the EKG to be administered and read and for medical decisions to be made. So, Memorial overturned traditional hospital hierarchies. Nurses, paramedics and EKG technicians were given decision-making roles and cardiologists surrendered some of their authority.

Ross said the changes in cardiac care, including giving more responsibility to the paramedics, reflect an overall trend in Colorado Springs.

“We’ve trained the medics to be able to give standard medications,” he said. “And that frees up the time of ER doctors and nurses.”

At Memorial, months of meetings and discussions resulted in a single treatment protocol: every patient suffering from AMI is sent to the catheter lab for PCI. The reason: studies show that the PCI treatment has a slightly better survival rate.

Treatment times

The National Institutes of Health ranks every hospital in the United States for time from “door to balloon.” In 2005-06, about 67 percent of patients nationwide had their arteries unblocked within two hours.

At 91 percent, Memorial ranks among the finest cardiac care hospitals in the country. The University of California San Francisco Medical Center has only achieved a rate of 77 percent.

Heart attack symptoms
Chest discomfort
Feeling lightheaded
Pain or soreness in the arm, neck or back that lasts several minutes
Feeling sick to your stomach
Feeling short of breath
Feeling sweaty
Feeling fatigued

The symptoms don’t always mean a heart attack is happening. That’s why getting emergency medical care — immediately — is a must.

And whatever you do, don’t try to drive yourself to the hospital. Sophisticated care begins the moment the first responders reach you — so driving to the hospital actually prolongs the time you go without treatment rather than shortening it.

Source: Memorial Hospital

Loehr, however, downplays the accuracy of such statistics. There are, he said, anomalies in the NIH reporting system.

“How, for example, do you measure door-to-wire time for a patient who checks in on Thursday, and then has an AMI episode on Friday? Is it 30 minutes or 30 hours?” he asked. “And what if the hospital has a reputation for treating the very sick? Very sick people are going to go there, and their rates are going to be lower.”

Regardless of national measurements, Loehr said there is always room for improvement.

“We’re shooting for an average time of 60 minutes,” he said. “And we’d like to get patients from door to cath lab within 30 minutes.”

Both UCSF and Penrose use more traditional treatment protocols which are more time-consuming.

Sharing the success

More hospitals are taking notice of Memorial’s practices.

Hamstra has discussed the program at the American College of Cardiologists, the International Healthcare Institute and the Volunteer Hospital Association.

“And it isn’t ‘why didn’t we think of this,’” Hamstra said. “It’s more, ‘wow, this can really work.’”

Hamstra said that by shifting the focus to the outcome — to save lives — the process became an exercise in “how to” instead of “why not.” Once the cardiologists and emergency room doctors signed on, the rest was easy.

“Cardiac Alert is a hospitalwide procedure,” Loehr said. “If a patient checks in for a kidney stone and has a heart attack, the process is exactly the same. The same people are alerted; the same steps are taken.”

Amy.Gillentine@csbj.com
John.Hazlehurst@csbj.com