Hospital Buyer

When treating a heart attack, time is critical. Guidelines from the American College of Cardiologists and the American Heart Association suggest that patients eligible for cardiac catheterization (those with ST segment elevations on electrocardiogram) undergo the procedure within ninety minutes of coming into the Emergency Room. This time frame is referred to as “door to balloon” time. The Tri-City Medical Center, which serves northern San Diego residents, reduced its door-to-balloon time from 112 to 86 minutes.

A report from the North County Times details use of telecommunications tools to increase the speed of response for heart attack victims. Using funds from the Tri-City Healthcare Foundation, portable electrocardiograms in ambulances and fire trucks have been linked to cellular devices that communicate directly to wireless equipment in the emergency room. The physician can review the patient’s study while being transferred and begin immediate treatment planning, including notification of the cardiac catheterization team. To further streamline this process, the Tri-City cardiac catheterization team can be reached by dialing one phone number. Previously, each of the five members of the team had to be contacted individually.

Tri-County also installed an electrocardiogram machine in the primary triage facility of the emergency room to handle patients who are not transferred by ambulance. Patients with heart attack symptoms can undergo EKG while in triage. This facilitates early identification of patients with ST elevation who should be considered for cardiac catheterization.

A study published in the New England Journal of Medicine from November 2006 considered factors which hospitals could moderate to reduce the critical door-to-balloon time period. Authors found an average door-to-balloon time of 100.4 minutes among the 365 facilities surveyed. The study pinpointed approaches to decrease door-to-balloon time:

• Capability of ER physicians to notify cardiac catheterization teams for incoming patients;
• Activation of Cath Staff through one call;
• Supporting ER activation of the Cath Lab while a patient is en route;
• Requiring Cath Lab staff to arrive at the Lab within 20 minutes of notification;
• Keeping a Cardiologist in house at all times;
• Using ongoing feedback to update staff on performance in real time.

Study authors noted that few hospitals had integrated the approaches enumerated. The study provides further evidence about the utility of these strategies to reduce door-to-balloon time. The recent report from Tri-City Medical Center supports the reduction in time brought by these strategies as well as the practicality of implementing them.

March 6, 2007 Related topics: Wireless, Diagnostic, Emergency, Cardiology, Policies & Procedures