CLINICAL EVENTS CALENDAR
- StartOct 22,2008EndOct 23,2008The Joint Commission Presents Laboratories: Accreditation Essentials (Beginner: 10/22; Advanced 10/23)www.cathlabdigest.com
- StartOct 23,2008EndOct 23,2008Introduction To Cardiovascular Cath Labwww.socalmeded.com
- StartOct 25,2008EndOct 25,2008Cath Lab Basics ‘08 with Dr. Morton Kern and Dr. Michael Limwww.cathlabdigest.com/basics2008/
- StartOct 30,2008EndOct 30,2008Introduction To Cardiovascular Cath Labwww.socalmeded.com
Non-Accredited Education
 CLINICAL EXPERIENCE WITH A NEW HYBRID CORONARY WIRE On Demand Web Archive Non-Accredited Target Audience: Physicians, nurses, and technologists. This activity is supported by an educational grant from Terumo Medical Corporation. |
Stemi Interventions
Innovations in STEMI Interventions – Improvements in D2B Times through Medical Simulation
A report from the upcoming February 2009 LUMEN meeting
The STEMI process is comprised of three distinct processes — the pre-hospital EMS phase, the emergency department phase and the cardiac cath lab phase. Each phase has its own skilled people conducting their own specialized work. To increase STEMI procedure success and meet mandated door-to-balloon time guidelines, these processes must be streamlined and made more efficient through the creation of a standardized process and the following of approved protocols. Most STEMI procedures become chaotic as a lack of cohesive teamwork.
Dr. Sameer Mehta is a STEMI world expert who has been studying the STEMI process and procedures, as recorded in his SINCERE database, and discussed in the Textbook of STEMI Interventions.
Dr. William Hamman is a systems expert, a commercial pilot and a cardiologist who has been using simulation processes to increase system efficiencies, reduce costs and promote patient safety.
A Field ST-Elevation Myocardial Infarction (STEMI) Program
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Developing partnerships with local EMS providers to decrease door-to-balloon times
Summary
The American College of Cardiology guidelines for “door-to-balloon” time identify evidenced-based practice as less than 90 minutes for patients experiencing a heart attack and “door to door-to-balloon” time as less than 120 minutes. Initial data collection revealed that our hospital was experiencing door to door-to-balloon times of up to 240 minutes with an average of 146 minutes. Analysis of the process showed that patients calling for emergency response would be brought to the nearest emergency department (ED) (i.e., the first “door”) and subsequently transferred out to a facility (the second “door”) capable of performing percutaneous coronary intervention (PCI). The problem was clearly identified as delays in getting the patient to an interventional hospital for immediate treatment.
Code 42: A Quality Initiative Program for Improving Door-to-Balloon Times in ST-Elevation Myocardial Infarction
ABSTRACT: Resurrection Medical Center implemented an initiative to address patients presenting with an ST-elevation myocardial infarction (STEMI). This facility followed their performance improvement process using evidence-based strategies in order to comply with standards set by accrediting bodies. Quality improvement staff nurses take an active role in this practice. Because of this quality initiative, there has been a positive effect on the quality of care on this specific patient population.
Quality Today
Quality initiatives are a hot topic in today’s healthcare arena. Healthcare consumers now can pick and choose where they receive healthcare services. Consumers want and expect the best treatment and care when they walk into a healthcare facility. Yet patients do not always receive the best in quality.1 Because of consumers’ interest in excellence and compliance with quality indicators, healthcare facilities are looking to improve their quality scores.
STEMI INTERVENTIONS: Commentary
Two outstanding STEMI experiences are highlighted in the present issue of Cath Lab Digest. They have been submitted from hospitals in Ohio and California, and both demonstrate superb STEMI processes in action. Both institutions deserve praise for their robust efforts in mastering the process of STEMI intervention. As a result of their meticulous teamwork, the challenge of achieving consistent door-to-balloon (D2B) times of < 90 minutes, both on- and off-hours, was easily surpassed at both institutions. Readers can pick up valuable tips from their experience. Several of these have been previously highlighted in various STEMI sections of Cath Lab Digest — the publication that continues to lead the way in its mission to educate cardiovascular professionals about short D2B STEMI interventions.
Changing the Standard of Care in STEMI PCI
Combining Mechanical Reperfusion and Pharmacologic Therapy to Improve Myocardial Perfusion
Case 2 of 5: Continuation of STEMI Case Series from September 2008 Cath Lab Digest
History of Present Illness
A 57 year-old male was brought to the Harrisburg Hospital emergency room via ambulance for ongoing severe chest pain of 1 hour’s duration. He was determined to have acute inferior wall myocardial infarction by electrocardiographic (ECG) criteria. A Code STEMI protocol was initiated by the emergency room staff. The patient immediately after arrival to the ER went into ventricular fibrillation and was successfully cardioverted to a normal sinus rhythm. He received aspirin 325 mg, clopidogrel 600 mg, intravenous (IV) metoprolol, heparin, and IV amiodarone. He was immediately taken to the cardiac catheterization laboratory for primary percutaneous coronary intervention (PCI) of the infarct-related artery.
Improving Door-To-Balloon Time: Partnerships for Excellence
An estimated 500,000 STEMI events per year occur in the United States. Evidence shows that rapid restoration of flow in the obstructed infarct artery is a key determinant of short- and long-term outcomes of STEMI patients.1 The focus to improve quality in the delivery of rapid primary percutaneous coronary intervention for ST-segment elevation acute myocardial infarction (STEMI) has never been greater than the present at Banner Desert Medical Center in Mesa, Arizona. Most facilities are involved in improvement projects that seek to achieve the target of door to primary percutaneous coronary intervention (PPCI) time within ninety minutes.
STEMI INTERVENTIONS: Commentary I
Sameer Mehta, MD, FACC, MBA, is studying ST-elevation myocardial infarction interventions in his work with short door-to-balloon time primary PCI and the Single INdividual Community Experience REgistry for Primary PCI (SINCERE) database at 5 community hospitals in Miami, Florida, now over 343 patients. A past chief of interventional cardiology and director of the cardiovascular laboratory at Cedars Medical Center in Miami, as well as former President of the American Heart Association (Miami Dade Division), Dr. Mehta is a Voluntary Associate Clinical Professor of Medicine at the University of Miami-School of Medicine. Dr. Mehta is also president of the Indo-American Society of Interventional Cardiologists (ISIC) and a course director for LUMEN 2009: The Symposium on Optimal Treatments for Acute MI. He has recently published the Textbook of STEMI Interventions (available through HMP Communications at http:// www.stemiinterventions.com).
The Essence of STEMI Interventions – Understanding the Process and the Procedure
A short door-to-balloon time (D2B) ST-elevation myocardial infarction (STEMI) intervention has two major components that must be well understood to achieve the desired benefits of primary percutaneous coronary intervention (PCI). These components include the STEMI “process” — the series of actions, including the essential pre-hospital component, that deliver a STEMI patient to the cardiovascular laboratory in an expedited fashion, and the “procedure” that results in rapid restoration of epicardial and myocardial perfusion to the infarcting heart.
The success of outstanding primary PCI programs in Europe, Canada and at numerous U.S. centers is primarily a result of mastering both the “process” and the “procedure” of a STEMI intervention.1-6
Four Members of a STEMI Team and Similarities to Running a Relay
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CME Showcase
Diagnosing Coronary Artery Disease: Advanced Cardiovascular Imaging Solutions Complimentary accredited web archive This activity is intended for physicians, nurses, and technologists. Treatment Options for the AF Patient A-fib Ablation:  New Standards of Care for CRMD Antibiotic Protection Complimentary CME Accredited Webcast Dates: November 18, 2008 Time: 6:00 pm ET November 19, 2008 Time: 3:00 pm ET This activity is sponsored by the North American Center for Continuing Medical Education. |
 LUMEN 2009 - THE SYMPOSIUM ON OPTIMAL TREATMENTS FOR ACUTE MI Live Symposium Date: February 26-28 Location: Loews Miami Beach Hotel Miami Beach, Florida 33139 This activity is sponsored by the North American Center for Continuing Medical Education. |
 Hemostasis Management in Today’s Cath Lab Complimentary Accredited Web Archive Release Date: June 19, 2008 Expiration Date: June 19, 2009 Target Audience: This activity has been developed for physicians, nurses, and technologists. This activity is supported by an educational grant from Radi Medical Systems, Inc. |
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The Perfectly Integrated STEMI Model: Commentary
Sameer Mehta, MD, FACC, MBA, is studying ST-elevation myocardial infarction interventions in his work with short door-to-balloon time primary PCI and the Single INdividual Community Experience REgistry for Primary PCI (SINCERE) database at 5 community hospitals in Miami, Florida, now over 365 patients. A past chief of interventional cardiology and director of the cardiovascular laboratory at Cedars Medical Center in Miami, as well as former President of the American Heart Association (Miami Dade Division), Dr. Mehta is a Voluntary Associate Clinical Professor of Medicine at the University of Miami-School of Medicine. Dr. Mehta is also president of the Indo-American Society of Interventional Cardiologists (ISIC) and a course director for LUMEN 2009: The Symposium on Optimal Treatments for Acute MI (www.lumenAMI.com). He has recently published the Textbook of STEMI Interventions (available through HMP Communications at http://www. stemiinterventions.com).