STEMI protocol at KVCH speeds patient care and saves lives
STEMI is another term used to describe heart attack. ST-segment elevation myocardial infarction is a type of heart attack where one or more of the heart's arteries are blocked. “When an artery that feeds the heart is blocked, then part of the heart is not getting oxygenated blood and heart cells in that part of the heart begins to die,” said Dr. Kipp Alan Young, M.D, FACEP, emergency director at KVCH. Dr. Young said dead cells cannot be replaced and the damage becomes irreversible. “That is why it is critical to open the clogged artery quickly before permanent cell death occurs.”
A Patient's Story from the ER
“J” was brought to the KVCH emergency room with a diagnosis of chest pain. She was also short of breath, sweaty, and very nauseated. The Emergency Department staff at KVCH recognized these symptoms immediately. A picture of her heart rhythm (EKG) was obtained within three minutes of her arrival and the suspected diagnosis was confirmed. The patient was having a STEMI (a ST segment elevation myocardial infarction). During the next few minutes, the patient was treated with intravenous fluids, pain and other medications to stabilize her condition. Just as quickly as she was admitted to the Emergency Room, she was transported by Ellensburg Fire Department to Yakima Regional Hospital's Cardiac Catheterization Lab. The total amount of time that elapsed from her arrival to the Emergency Room to the opening of her diseased vessels was approximately 70 minutes.
“Time is of the essence during the initial onset of a heart attack. KVCH's emergency department is consistently prepared to meet this emergent need,” said Jim Allen, director of respiratory therapy. Allen said the average time it takes the KVCH emergency team to prepare a STEMI patient for transport to Yakima Regional Hospital's cardiac catheterization lab is 15 minutes.
In a concerted effort, KVCH, Kittitas County EMS and the cardiac catheterization lab at Yakima Regional Hospital put protocols in place to reduce what is referred to as door-to-balloon time.
Door-to-balloon time is defined as the time a patient arrives at the hospital, and ends when the artery has been opened to re-establish blood flow. The American College of Cardiology has set the standard for door-to-balloon time at 90 minutes. After 90 minutes, research has shown that patient outcomes can deteriorate rapidly. Together, KCVH and Regional Hospital have been averaging 71 minutes from door (KVCH emergency room) to open artery (Regional's cath lab). This time includes the 35 minute ambulance drive between hospitals.
Allen said the only way to determine that if an artery is blocked is with a 12 lead EKG. “If the EKG indicates a STEMI patient, KVCH's emergency team springs into action,” said Steve Collins, KVCH emergency department director. A designated STEMI room is ready to supply the patient with oxygen, pain medication, and medication that helps open the artery in the heart.
Corinne Murphy-Hines, executive director cardiovascular services at Yakima Regional Hospital, said that the cooperation between the two facilities has significantly improved the care for patients suffering from heart attack. “Even with the drive time, we (KVCH and Yakima Regional Hospital) have the patient's door-to-blood flowing at the same time or better than some hospitals if the ER and cath lab were in the same facility.” As soon as the cath lab receives a call from KVCH that a STEMI patient is on the way, Murphy-Hines said, “We gather the troops.”
Sharon Johnson, director of quality management at KVCH, monitors STEMI patient data, “Our interdisciplinary team work has reduced the time it takes to prepare the patient for transport down to less than half of what it was originally. This translates to saving heart muscle and saving lives.”
Less than 20 percent of patients entering the emergency department at KVCH with chest pains actually have a STEMI. In addition to the STEMI program, KVCH treats many other heart conditions such as congestive heart failure, coronary artery disease and heart attacks in the emergency department, and patients remain at KVCH for treatment.
“Our mission here at KVCH is to provide excellent and compassionate healthcare” says Craig Wilson, patient care administrator and chief nursing officer. Wilson says that KVCH is committed to being a leader among Washington State hospitals in the care of STEMI patients. “STEMI care is not the only area, however, where we excel when we benchmark our performance to other hospitals. Kittitas County residents can feel very confident in the quality care and treatment they will receive throughout our organization.”
The emergency department at KVCH provides 24-hour urgent and emergent medical care with certified emergency physicians on duty 24-hours-a-day, assisted by a team of emergency-trained registered nurses, nursing assistants and support staff.
