Do You Want To Be Waiting In An ER If You Have A Heart Attack?
Posted by khcblog on July 22, 2009
According to a recent Iowa Hospital Association “Quality Indicator Report” for the first quarter (Jan-Mar) of 2009. If you have the misfortune of having a heart attack – Knoxville Hospital & Clinics provides immediate treatment and gets you to a hospital with a cardiac cath lab 36 minutes faster than our peer group and state of Iowa hospital averages.
According to Iowa Hospital Association “Quality Indicator” reporting for the first quarter of 2009 (see chart below), patients that presented to our emergency department are transferred to a hospital with a cardiac cath lab in 59 minutes – as compared with our peer group and state of Iowa averages of 95.61 minutes.
According to the American Heart Association, every year, 1.5 million Americans will have acute myocardial infarctions (heart attacks). Of those, approximately 400,000 die. A heart attack or Acute Myocardial infarction (MI) occurs when the blood vessels supplying the heart with oxygen, become clogged by blood clots or plaques. Once the blood flow has been interrupted, the heart muscle begins to die. If blood flow is not restored within a brief time frame, irreversible damage to the heart muscle will begin to occur, which frequently leads to death.
The goal of care at KH&C is to immediately treat patients showing signs and symptoms of heart attack and once diagnosed, to restore blood flow as soon as possible. The primary intervention used to restore blood flow to these patients is cardiac catheterization, (balloon).
The federal government (CMS) implemented an industry-wide standard set of Core Measures developed to help improve outcomes for these patients. “Door-to-balloon” is a time measurement in emergency cardiac care (ECC), specifically in the treatment of ST segment elevation myocardial infarction (or STEMI). The interval starts with the patient’s arrival in the emergency department, and ends when a catheter guidewire crosses the culprit lesion in the cardiac cath lab.
Because of the adage that “time is muscle”, meaning that delays in treating a myocardial infarction increase the likelihood and amount of cardiac muscle damage due to poor oxygenation of tissue, The American Heart Association guidelines recommend a door-to-balloon interval of no more than 90 minutes.
As a rural hospital, Knoxville Hospital & Clinic’s main goal is to start the initial interventions and get these patients to a higher level hospital like Mercy Hospital or IMMC in Des Moines where they can have the balloon procedure as soon as possible.
The core measures we can impact in the care of these patients are:
- Administration of aspirin to everyone who does not have a contraindication within the first 24 hours of admission.
- Administration of a 12 lead EKG as soon as possible upon arrival.
- Cardiac Catheterization (PCI) within 90 minutes of arrival
We are very proud of the work we have done in improving our process with Acute MI patients here in our Emergency Department as evidenced by Iowa Hospital Associations Quality Indicator Report (below) for 2009’s first Quarter:
- Average Aspirin administered at KH&C = 100% – Peer Group Average = 91.35% – State Average = 92.38%
- Average length of stay prior to 12 Lead EKG at KH&C = 10 minutes – Peer Group Average = 12.11 minutes – State Average = 11.73 minutes
- Average lenth of stay prior to transfer at KH&C = 59 minutes – Peer Group Average = 95.61 minutes – State Average = 95.61 minutes
