Making STEMI a Priority: How the challenge differs at a large metropolitan medical center

Larry H. Brown, RN, BSN, CNOR, Cardiac Catheterization Laboratory, St. Luke's Episcopal Hospital, Houston, Texas
Larry H. Brown, RN, BSN, CNOR, Cardiac Catheterization Laboratory, St. Luke's Episcopal Hospital, Houston, Texas
St. Luke's Episcopal Hospital, home of the Texas Heart Institute, figures prominently in the campus of the Texas Medical Center in Houston, Texas. It boasts one of the largest cardiac catheterization laboratories in the world, devoting three labs to electrophysiology studies (cardiac mapping, bi-ventricular automatic implantable cardioverter defibrillators [AICD], pulmonary vein ablations, permanent pacemakers [PPM]), three labs to peripheral vascular procedures (abdominal aortic aneurysm repair, limb salvage, carotid and peripheral stenting), and the remaining five labs to coronary procedures (diagnostic, percutaneous coronary interventions [PCI], atrial septal defect/patent foramen ovale [ASD/PFO] closure, valvuloplasty, Rotoblater, laser, etc.). St. Luke’s also has two hybrid suites located within the cardiovascular operating rooms that perform combination percutaneous and surgical procedures. The lab is open for scheduled procedures 16 hours per day, Monday through Friday, and 12 hours on Saturday and Sunday. The remaining hours (Monday-Friday 11pm-7am, and Saturday-Sunday 7pm-7am), the lab is available for emergencies, covered by a four-person call crew consisting of 2 RNs and 2 technologists. All members of the clinical staff take call duty and must be cross-trained to function effectively in all types of emergency cases, including PCI for STEMI patients. As we all know, the public is still very much in denial about heart disease. Patients frequently ignore signs and symptoms of a heart attack, instead of calling 911 for immediate assistance. Patients or family members will drive to a hospital instead of calling for an ambulance when all signs indicate they are experiencing a myocardial infarction. While our efforts do not address these issues, we have worked to assure that once a patient arrives at our hospital, each minute will be used effectively and efficiently to provide the patient with the best chance for recovery and a healthy life. It is pretty straightforward for any hospital to get a STEMI patient to the cath lab when the emergency medical team (EMS) gives you a 30-minute warning prior to delivering the patient to the ED. It also presents less of a challenge in the middle of the day with all resources readily available in-house. Making the door-to-balloon time in Larry H. Brown can be contacted at lbrown@sleh.com