Cath Lab Digest

Can you share more about Baystate Medical Center’s door-to-balloon time initiative?
Dr. Giugliano: We pride ourselves in treating our acute myocardial infarction population and achieving goals in how rapidly we reperfuse their obstructed vessel. It is a national effort and something that we have been able to significantly improve upon, from the time the patient hits the door of our emergency room to the time a balloon is inflated in their artery to restore flow. That is the most important clinical outcome that has changed, in no small part due to the improved workflow.
Dr. Schweiger: We’re in the top 10% of the hospitals in the country for door-to-balloon time, and we have a very busy program. To be fair, we don’t only use the new Siemens lab for our STEMI patients. The fact is that we have a number of labs, but the Artis zee lab is a pleasure to use; it’s easy to get people in, get them on the table and get them started. That’s certainly contributed toward that initiative.
Dr. Schweiger: We’ve been at this for a good couple of years. We’ve broken it down: first of all, what’s most important is good communication with the emergency room (ER). We have various time checkpoints, the door-to-EKG, EKG to calling the interventionalist, and taking the patient to the lab. We work to improve our times at every one of these checkpoints. The ER calls in the whole team. We obviously have people on 24 hours a day. The ER puts out the page — acute STEMI — and the people involved know to get right to the lab at night. We have also begun having EMS do EKGs in the field, which saves a tremendous amount of time. To be honest, there is no one thing that has led to our improved door-to-balloon times. It’s a collection of efforts across an entire collaborative system. We look at our results every quarter, and surprisingly, we continue to get better. I think it becomes a mindset and a little bit of a game; if you are the interventional cardiologist on call, you want to get that artery open as quickly as you can because: a) we know it’s good for the patient, but b) because we’re all competitive. Dr. Giugliano: There are people out there who have been doing it longer and/or better, and we have not been shy about trying to learn from others to take away points that can improve our own program. You don’t have to copy everything from other programs; I think every program probably tweaks things a little differently, but there is always something you can learn. We’ve visited Minnesota, Boston and elsewhere, and all of these things add up to getting us into that top percentile. In addition, communication cannot be emphasized enough. We have regular meetings with our ER physicians, nurses and critical care unit nurses, to talk about every single acute myocardial infarction we do. If there is an outlier leading to any delay at all, there is an effort to try and identify the cause.