Cath Lab Digest - December 2007 - (Page 14) 14 STEMI INTERVENTIONS DECEMBER 2007 e-mail reports are of a generic nature and review procedural performance without disclosing any pertinent patient medical record information that might violate HIPPA standards. In composing these e-mails, I can review the EKG, the ED record, angiograms, talk to the rapid response nurse who assisted with transport to the CCL, talk with the cardiology fellow and staff cardiologist and then draw all this information into a concise report that lets everyone know not only what happened to the patient, but why it happened. For example, the last email sent out reviewed the case of a patient with a totally occluded right coronary artery (RCA). The email discussed the case in detail. Angiograms confirmed a totally occluded RCA, consistent with the EKG that showed ST-elevation in the inferior leads, supporting the need for a physician order to complete a rightsided EKG when the EKG suggests inferior involvement. It would also explain the bradycardia and why the cardiologist chose to put a temporary pacer wire in during the procedure, because an occluded RCA can have a significant effect on the A-V node, etc. As each of the staff has a chance to participate in these procedures, it extends and reinforces our clinical knowledge. The benefits of providing this kind of follow-up have had a very positive impact on the staff. Make the right move Place a classified ad in For deadlines, rates, and more information please contact: Classified Ad Manager Lucinda Beska-Ext 235 Erin Fehr-Ext 271 Classified Ad Associate Phone: (800) 237-7285 Fax: (610) 560-0501 Email: lbeska@hmpcommunications.com efehr@hmpcommunications.com Another significant challenge was to develop a standardized equipment list and outline a suggested procedure protocol for the cardiac cath lab, an idea suggested by one of the staff cardiologists at St. Luke’s. Cardiologists at St. Luke’s Episcopal Hospital are used to doing complicated, high-risk PCI procedures, one of the reasons for our very existence. Our inventory of supplies is probably double or triple what you might find in a smaller hospital. For instance, our cardiologists may study films for some time before deciding what particular guiding catheter should be used in a complex case. STEMI patients meant a change in mindset for the cardiologist. We have over 40 cardiologists on staff that have interventional privileges. Sixteen of these cardiologists take regular AMI call for the ED. Any one of these physicians might be called upon to perform a PCI for a STEMI patient. St. Luke’s is also a teaching hospital with a four-year cardiology fellowship program. STEMI patients need to get their artery open and they need it opened immediately. While STEMI patients are certainly an opportunity to learn, it is not the best time to teach a new fellow how to seat a guiding catheter or pass a wire across a lesion. Getting so many cardiologists to agree on a small standard inventory of guiding catheters, wires, and a couple of balloons that could fit on one moveable cart was not an easy task. Once the list was decided upon and the cart stocked, I placed a small sign on the cart that said, “Just get a guide, get a wire, and get a balloon and GET’ER DONE!” (my attempt at a little levity in an otherwise serious and stressful situation.) In conclusion, helping to set up a standardized STEMI program at St. Luke’s has been a rewarding experience. We have reduced our mean doorto-balloon time from 111 minutes for the first five months of 2007 to 57 minutes for the following five months. Compliance in meeting the < 90 minutes goal has gone from < 25% to 100%. Through administrative support, physician cooperation, and the active and positive participation of the hospital staff, we have put procedures and processes in place that will ensure that the standard of a less than 90minute door-to-balloon time will be consistently met, whether St. Luke’s sees one or two STEMI patients per month or fifty. ■ Larry H. Brown can be contacted at lbrown@sleh.com
For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.