To improve efficiency and quality of cardiac care, Charlotte, N.C.-based Carolinas HealthCare System participated in the Regional Approach to Cardiovascular Emergencies project, a statewide initiative to treat heart attack patients as quickly as possible. The RACE program uses standards from the American Heart Association’s Mission: Lifeline STEMI program, which also focuses on creating systems of care for heart attack patients. RACE has been successful in reducing the time it takes for hospitals to treat heart attack patients.
Lee Garvey, MD, director of emergency cardiac care at CHS’ Carolinas Medical Center in Charlotte, and Hadley Wilson, MD, medical director of adult cardiology at CHS’ Sanger Heart & Vascular Institute, share five strategies to speed care for heart attack patients.
1. Institute a continuous improvement process. Cardiac care teams should employ a continuous improvement process to continually reach for higher goals. “We thought we had a pretty good program when we began because the time [from patient arrival to percutaneous coronary intervention] was 92 minutes,” Dr. Garvey says. “But, we realized that half the patients [were] treated beyond the 90-minute treatment goal, so we instituted this continual process improvement initiative.” Due to this initiative, CHS has reached 100 percent compliance with the 90-minute goal and is nearing 100 percent compliance with the system’s new goal of 60 minutes.
2. Complete tasks in parallel. Whenever possible, physicians and staff should complete steps at the same time rather than sequentially. For example, a nurse can administer medication while a physician orders lab tests, or the catheterization lab can be prepared as the patient is transported to the hospital by ambulance.
3. Minimizing transfers. CHS learned one way to save time is to not transfer patients from the stretcher they’re brought in on to a hospital bed. Instead, the patient is brought directly from the gurney to the catheterization lab for treatment.
4. Treat interfacility transfers as traumas. In the past when heart attack patients had to be transferred from one CHS hospital to another, the transport was handled as an ordinary interfacility transfer. “We needed to change that mindset,” Dr. Garvey says. “We learned we needed to apply other tools we’ve used for other time-critical issues like trauma.”
Now, interfacility transfers are conducted with urgency — the ambulances use high-priority lights and sirens and helicopters “hot load” patients.
5. Hot load. Another time saver is hot loading — keeping a helicopter’s rotors running when picking up a patient who needs to transfer to another hospital, according to Dr. Wilson.
More Articles on Hospital Cardiology:
The RACE to Treat Heart Attack Patients: A Regionalized Approach by Carolinas HealthCare System
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