Streamlined processes and STEMI networks are among the efforts being used to improve care for heart attack patients.
This article first appeared in the July/August 2014 issue of HealthLeaders magazine.
Not too long ago, if an ambulance was called to help someone experiencing an ST-elevation myocardial infarction, the EMS workers would routinely take that person to the nearest hospital. If that facility wasn't equipped to treat such a severe heart attack, physicians had two choices: Administer the patient thrombolytic clot medicine and hope for the best, or find another hospital that could accept a STEMI patient and arrange for transport, wasting valuable time.
But now, at a growing number of organizations around the country, heart attack receiving centers are developing a number of ways to streamline that process, including creating STEMI networks within their region and educating EMS workers so that they can perform EKGs and activate the heart attack receiving center's cath lab while still on the road.
In 2012, the American Heart Association and the Society of Cardiovascular Patient Care began accrediting hospitals that participate in and meet certain standards for these coordinated systems of care for STEMI. To be accredited, hospitals must guarantee percutaneous coronary intervention readiness 24/7, coordinate with EMS and referral centers, facilitate STEMI patient transport, collect data, and measure performance, among other measures. Once the patient arrives at the receiving center, the door-to-balloon time should be within 90 minutes.
Summa Akron (Ohio) City Hospital received the American Heart Association's Mission: Lifeline accreditation in 2012. The 550-bed facility began using PCI to treat STEMI patients in 2004 and immediately began to address referral issues, standardizing treatment protocols for all STEMI patients. The organization then adopted the tenets of the American College of Cardiology's door-to-balloon initiative and began to affiliate with more local hospitals and expand its STEMI network.
"We really embraced the whole concept because it was very consistent with what we were doing, and getting the receiving center [certification] was validation of a lot of the work that we had done," says Kenneth Berkovitz, MD, chairman of the cardiovascular disease department at Summa Akron City and St. Thomas Hospitals, and medical director of Summa Cardiovascular Institute, which comprises more than 50 cardiologists and cardiothoracic and vascular surgeons, four hospitals, and 15 physician offices. "As providers this has been very easy for us to embrace, and it has been a really great team-building strategy and a great alignment strategy for us."
Success key No. 1: Building external partnerships
Danville, Pennsylvania–based Geisinger Health System has two hospitals with AHA-accredited heart attack receiving centers—Geisinger Medical Center, a 422-licensed bed facility that performs about 220 PCI procedures for STEMI patients each year, and Wyoming Valley, a 242-licensed-bed facility that performs about 100 procedures for STEMI patients a year. Geisinger credits much of its success to its neighboring hospitals and referring centers.
Marianne Aiello is a contributing writer at HealthLeaders Media.