The SSM Heart Institute at St. Mary’s Health Center was among the few heart programs across the country last year to perform 100 percent of emergent balloon angioplasties in under 90 minutes — a proven best practice and the gold standard set by the American College of Cardiology, American Heart Association and the Centers for Medicare and Medicaid Services (CMS). Angioplasty is a procedure that opens blocked coronary arteries that supply blood to the heart.
This amazing achievement is the result of an exceptional team of cardiologists, emergency medicine physicians, nurses and others who work tirelessly to provide the best care and best results for patients who suffer a heart attack. In fact, St. Mary’s average door-to-balloon time is just 64 minutes — day or night.
Every minute counts in saving the heart muscle from damage and saving the patient’s life. For every 15 minutes that passes before angioplasty, an estimated six of 1,000 heart attack patients die. Unfortunately, less than 15 percent of U.S. hospitals consistently perform emergent PCI in under 90 minutes from the time of presentation.
Dr. Kiran Kancherla, director of Cardiology at St Mary’s and a member of the SSM Heart Institute, oversees the hospital’s chest pain/heart attack team. “We are all extremely proud of this achievement,” he said. “Our ER staff and cardiac catheterization lab have worked very hard over the last few years, constantly looking at the door-to-balloon time, and continuously striving to improve every part of the process to quickly treat our patients with heart attacks. At one time, we even had a stopwatch that stayed next to the patient’s bedside so everyone involved in the patient’s care realized how important every minute is.”
The cardiac cath lab, cardiologists, ED staff and emergency medicine physicians collaborated to establish a “Code MI” protocol. The team then educated everyone involved and even conducted drills to ensure success. They implemented a process that allows ED physicians to activate the cath lab at any hour by a single phone call; and the cardiac cath team committed to arriving within 30 minutes to provide emergent angioplasties. In addition, the ED team worked with area EMS to implement protocols that allow for 12-lead ECG reports to be submitted to the ED prior to patient arrival.
“The placement of the Chest Pain Center in the ED also has enhanced our ability to manage patients with chest pain and possible heart attacks,” Dr. Kancherla said. “Chest Pain Center patients are seen by a board-certified cardiologist, who is able to quickly identify a heart attack.”
Dr. Kancherla credits SSM St. Mary’s team of interventional cardiologists who commit to being onsite on short notice — 24 hours a day — to open blocked arteries and save patients. And he applauds the tireless work of the cardiac cath lab nurses to achieve exceptional heart care.
“I can’t tell you how passionate the cardiac catheterization laboratory nurses are in putting our patients first and pushing themselves hard to reach the door-to-balloon goals,” he said. “For example, Janice Mueller is one of our cardiac cath nurses who has made personal sacrifices to ensure excellent care for our patients. Because she lives close to the hospital, Janice knew she could get to the cath lab before anyone else. From the beginning, Janice would come in the middle of the night, regardless of whether she was on call or not, to help get the patient’s artery opened before the 90-minute goal.”
Mary McBride, St. Mary’s director of cardiology, said the door-to-balloon success is the result of education and communication, partnership across departments and with EMS, and the implementation of protocols to improve care. Through a very deliberate effort, the hospital achieved best practice and door-to-balloon times as low as 34 minutes. “We are so pleased with the results, but we won’t rest,” she said. “We’ll keep working to open blocked arteries as quickly and safely as possible.”