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With a five-minute head start from Boston Emergency Medical Services, BWH's Emergency Department received and diagnosed a patient having a heart attack and rushed her to the Cardiac Catheterization Laboratory for an emergency angioplasty.
Within 33 minutes of that patient's arrival at Francis Street, a team of BWH doctors, nurses and technicians unblocked an artery and restored the patient's blood flow to her heart, making this May case one of BWH's fastest “door-to-balloon” times.
Campbell Rogers, MD, director of the Cardiac Catheterization Laboratory, called this team accomplishment remarkable. Although impressive, it turned out to come in second to BWH's fastest “door-to-reperfusion” time-27 minutes-which occurred in March.
“The faster the reperfusion, the smaller the heart attack and the better the patient outcome,” he said.
As Emergency Medicine, Cardiology and the Cath Lab work to perfect this team response, national reporting agencies like JCAHO have set 120 minutes as a standard for door to reperfusion and are making hospital-specific data public in coming years. In the last year, the hospital's mean “door to balloon” was about 100 minutes, well below the benchmarks.
“Partners and BWH are working for comprehensive cardiac improvement, and specifically, working to minimize the time between a patient's arrival and treatment,” said Andrew Eisen-hauer, MD, director of the Interventional Cardiovascular Medi-cine Service, associate director of BWH's Cardiac Cath Lab and director of Cardiac Quality Improvement for Partners Health-Care.
These cases pose an unusual challenge because of the logistics involved. With this recent weekday case, for example, Boston EMS crews alerted Emergency Department staff that a heart attack patient was on the way at 11:50 a.m., and that's when ED staff notified Cath Lab flow manager, Elizabeth E. McDonald, RN, via pager.
As Emergency Department staff sprung into action, McDonald promptly notified an attending interventional cardiologist to the ED, arranged for a room in the Cath Lab, and organized radiologic and cardiovascular technologists, nurses and an interventional cardiology fellow. Charge nurse Steve Palmer and Emergency Medicine attending physician Everett Lyn, MD, and the ED staff prepared the ED Alpha Unit, registered and evaluated the patient, obtained an EKG, administered pre-catheterization medications and secured IV access and a breathing tube.
The team ran through a lengthy list in minutes, with each step vitally important to the patient's efficient transition to the Cardiac Cath Lab. “The details are crucial and time is of the essence,” Lyn said. “We work as a team to ensure that the patient and all vital information are transferred to the Cath Lab as rapidly as possible.”
Interventional cardiologist Andrew Selwyn, MD, escorted the patient to the Cath Lab, where the emergency angioplasty was performed and completed within 20 minutes.
“The team of professionals in the Catheterization Laboratory are so wonderfully focused on the best possible outcome for each patient, and that's how we achieve this level of care,” Selwyn said.