Wednesday, September 12, 2012

Just Trying To Save a Few Lives by Saving Time from Diagnosis of Myocardial Infarction to Balloon Angioplasty

Just Trying To Save a Few Lives: Tales of Life and Death from the ER

Title of Book by Pamela Grim, MD (Warner Books, 2000)

September 12, 2012 -   Most physicians start their careers with the notion they just want to save a few lives. For ER physicians,  the opportunity to fulfill this ambition often comes when a patient presents with symptoms of a heart attack and  ECG changes of an elevated ST segment.  Each year some 500,000 patients will experience chest pains or other symptoms of coronary occlusion with STEMI, doctor jargon for myocardial infarction with ST-segment elevation.

The best means of saving these patients and preventing further myocardial damage is to get these patients as quickly as possible to a cardiac cath lab where a balloon angioplasty to open the coronary artery can be performed.

How does one save time?   In an excellent article in the Septmeber 11 WSJ,  Laura Landro describes how. 

1.  Make diagnosis, skip consult with cardiologist,  call cath lab to prepare them for angioplasty.
Time Saved:  8.2 Minutes.

2.  Arrange for ambulance with ECG results to be transmitted wirelessly to cath lab can prepare for angioplasty while patient is en route.  Time Saved: 15.4 Minutes.

3.   Have central operator make single call to all cath lab members; Time Saved: 13.8 Minutes.

4.  Require cath lab staff to arrive within 20 minutes.  Time Saved: 19.3 Minutes.

5.  Have an attending cardiologist on site. Time Saved: 14.6 Minutes.

6.  Provide ER and cath lab staff with real time data feeback about their performance and time saved. Time Saved: 8.6 Time Saved.

Total Potential Time Saved: 79.9 Minutes.

Minutes Count.  Minutes saved may be difference between life and death and may prevent further myocardial muscle damage.  At the Cleveland Clinic,  the goal is to shorten the Door-to-Balloon time to less than 90 minutes.  They now achieve his goal 100% of the time, compared to 60% in 2011.  The median  time is now 47 minutes.

Tweet:  By shortening the time from diagnosis of myocardial infaction to balloon angioplasty, ER doctors can prevent further myocardial muscle damage and save a few lives.

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