Until recently, Sydney Vanderkraats had never heard of the “door-to-balloon team” at St. Mary’s Medical Center. But fortunately for Vanderkraats, the medical center had a program in place to provide the fast cardiac care that helped save her life after a heart attack.
The national door-to-balloon initiative began as a way to encourage hospitals to treat patients in need of angioplasty within 90 minutes of their arrival to the emergency room. St. Mary’s has embraced the concept, developing the door-to-balloon team that intervened in Vanderkraats’ case. Members of this team work by the credo “time is muscle.”
“A patient’s chance of survival and overall quality of life are greatly increased after a heart attack the sooner they can get to the emergency department and let our door–to-balloon team take charge,” said Kelli Klaiber, RN, BSN, CCRN-CMC, clinical manager of St. Mary’s cardiac cath lab. “In fact, for every 15-minute increment in door-to-balloon time, there are six fewer deaths per 1,000 cases.”
The door-to-balloon team is composed of medical directors, cardiologists, physicians, staff members and managers from the emergency room, cath lab and performance improvement department. Their goal is to treat patients who present at the emergency room within 90 minutes by opening the artery causing their heart attack. Once a person enters the door at St. Mary’s, the clock starts and stops when the artery has been successfully opened.
“Our research shows the 90-minute mark is clinically meaningful in terms of survivorship, overall health and well-being,” Klaiber said. “Our goal is to be able to obtain a door-to-balloon time of 90 minutes or less.”
In the last few months of 2007, St. Mary’s was meeting – and exceeding – the national standard. According to records, 100 percent of patients were treated within 90 minutes, with the average treatment time of 52.4 minutes in November and 62 minutes in December falling well below the initiative’s guideline. Their quickest treatment times have been 17, 25 and 29 minutes.
Many factors play into St. Mary’s ability to treat patients quickly. These include patients recognizing the signs of a heart attack and getting to the hospital as early as possible, and EMS workers getting as much information to the emergency room personnel as possible before arriving at the medical center.
“There are no negatives to this program for the paramedics, patients or hospital staff,” said Gordon Merry, director of Cabell County EMS.
Merry said the addition of Life Pack 12 units, which transmit EKG results in the field via cell phone, have enabled paramedics to effectively communicate with emergency room staff before arriving at the medical center.
“Ideally, we can send an EKG to the hospital while we’re on our way,” Merry said. “The ER doctor can interpret it and activate the cath lab, if necessary, and they’re waiting on us when we get there, knowing we have a patient coming who needs that artery opened. That drastically cuts down on the amount of time it takes to treat a patient and that’s a success all the way around,” Merry explained.
Merry felt so strongly about the ability to transmit EKG results via cell phone that all EMS personnel now carry the Life Pack 12 compatible phones. He even obtained a state grant for a new tower in the Salt Rock area which, he said, will help save lives.
“This is really going to make a difference in this part of the state because of the longer transport time,” Merry said.
Patients who choose to rely on a family member or friend for transportation to the hospital also receive a quicker treatment time. Patients who present at the registration desk with chest pain bypass the paperwork and go straight to triage then to receive an EKG, if necessary.
“Time is muscle, and we recognize that,” said Debra Parsons, director of emergency services at St. Mary’s. “It’s critical. We need to get a patient treated as quickly as possible for a better outcome. The more time it takes to arrive at the ER and be diagnosed, the more muscle is destroyed.
“The quicker you come in, the quicker we can open the vessel and the better the patient outcome,” she said. “We want to identify these patients and get them where they need to be as soon as possible.”
Vanderkraats certainly appreciates all the work to make the program a success. For several days before her heart attack, she did not feel well and complained of minor symptoms. At 3 a.m. one morning, Vanderkraats said it felt like an elephant was standing on her chest. She and her husband, Gil, rushed to get medical care.
“We ended up at another hospital where they gave me oxygen and nitro, and then loaded me up and told St. Mary’s I was on my way,” Vanderkraats said. “The only thing I can remember is pulling into the hospital and lying on the gurney. After that, I didn’t wake up until I was in intensive care.”
What St. Mary’s “door-to-balloon” team discovered was troubling. Vanderkraats’ arteries had 100-percent, 95-percent and 70-percent blockages.
“They told me that I was literally dying on the table,” she said. “I call Dr. (Paulette) Wehner ‘my angel’ because she saved my life.”
After Vanderkraats’ emergency procedure, she spent days under the watchful eye of the intensive care unit staff at St. Mary’s. At 69, she is still working, though she has cut her hours back considerably and does some of her work from home. She is faithful to attend St. Mary’s cardiac rehabilitation program and wellness center.
“If I hadn’t gone in there that night and had that procedure, I would be dead,” Vanderkraats said. “What a jewel we have in St. Mary’s Heart Institute.”
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