When a patient having a heart attack arrives in the emergency department (ED), the clock is ticking. And the clock keeps ticking faster and faster.
The American Heart Association (AHA) recommends that patients suffering heart attacks receive artery-clearing therapy as soon as possible. One option is balloon angioplasties within 90 minutes of arriving at the ED. Previously, the AHA recommendation for this procedure, called “door-to-balloon,” was 120 minutes. The association tightened the standard to save more lives.
Angioplasty is a procedure in which a tiny balloon is threaded into a narrowed heart artery and inflated to reopen blood flow. It is considered to be the most effective method of restoring blood flow to the heart.
Washington University emergency physicians and cardiologists continually look for ways to do even better than the recommended time it takes to diagnose patients arriving in the ED, activate its cardiac treatment team and initiate angioplasty procedures.
“There is a critical window when treating heart attack patients,” says Douglas M. Char, MD, associate professor of emergency medicine. “We know that patients who get treatment within this time period suffer less heart damage and have better outcomes.”
Some of the new measures ED physicians have taken include having paramedics at the scene fax or call in electrocardiogram results from the patient to the hospital. Within minutes, ED physicians activate the full angioplasty team.
To reduce “door-to-balloon” time even more, the catheterization laboratory has moved from Queeny Tower to one floor above the ED.
Additionally, ED physicians conducted time-motion studies to find other ways to speed up the process. The hallway to the cath lab elevator was reconfigured to shave minutes off the treatment time.
The American Heart Association awarded the hospital the Gold performance certificate in 2009 for emergency cardiac care.
“This is the result of cooperative efforts of the emergency department, the cardiac cath lab and the cardiac intensive care unit,” Char says.
The team that cares for patients with heart attacks in the ED meets monthly to review cases and find new ways to hasten the care heart attack patients receive.
“The 90-minute benchmark must be met, whether it’s Christmas Day or any other day,” Char says.