Date: 5/21/2007

Door to balloon time delivers quality outcomes to St. Mary Medical Center

Communication and teamwork between Emergency and the Cath Lab are at the heart of consistency and successful door to balloon times at St. Mary Medical Center, according to hospital performance improvement team members (left to right) Cheryl Alderson, R.T., cardiovascular radiologic technologist and manager of the Cardiac Cath Lab; Paula Rousis, R.N., nurse manager of Emergency Medicine; Debbie Krejci, R.N., Patient Care Services; and John Mulligan, M.D. of Emergency Medicine. Cardiologist Jack Ziegler, M.D., not pictured, also is a team member.

HOBART - They say timing is everything. In the case of patients who come to St. Mary Medical Center Emergency Department (ED) in Hobart complaining of chest pain, timing can be the difference between life and death.

Since the beginning of the year, medical professionals of St. Mary Medical Center ED and the Cardiac Catheterization (Cath) Lab have made a concerted effort to continuously surpass the quality of patient care benchmark by further reducing “door to balloon time.”

Door-to-balloon time refers to the interval between patient arrival and inflation of a balloon catheter within the patient’s blocked artery. The American College of Cardiology (ACC), along with other key national organizations (American Hospital Association, etc.) announced the latest quality campaign — “Door to Balloon (D2B)”: An Alliance for Quality in the late fall of 2006. The goal of the hospital and medical staff is to achieve a door-to-balloon time of 90 minutes or less. Patients included in this recommended timeframe are those with ST segment elevation myocardial infarction or STEMI (heart attack due to coronary blockage) who come to the hospital through the ED.

About 200,000 individuals each year have heart attacks cause by blockages in arteries supplying the heart with blood. About 100,000 of those patients die from these types of heart attacks. Studies indicate that reopening clogged arteries by inflating a tiny balloon at the site of the blockage is the best way to treat a severe heart attack. The procedure, balloon angioplasty, may reduce a patient’s risk of dying by about 40 percent, if it is completed within 90 minutes of the patient’s arrival at the hospital —the “door-to-balloon time.”

Medical staff, including John Mulligan, M.D. of Emergency Medicine at St. Mary Medical Center; Jack Ziegler, M.D., cardiologist; Debbie Krejci, R.N., Patient Care Services; Paula Rousis, R.N., nurse manager of Emergency Medicine and Cheryl Alderson, R.T., cardiovascular radiologic technologist and manager of the Cardiac Cath Lab formed the hospital’s performance improvement team. They realized that communication and teamwork would be the key to obtaining consistently successful outcomes.

Mulligan says, “We’ve set goals of door to EKG in 10 minutes or less; Emergency department notifying the Cath Lab team, 10 minutes or less; door to Cath Lab, a 45-minute goal, totaling door-to-intervention (balloon) at 90 minutes.”

Cooperation on behalf of several pre-determined teams from each department has proven to be a crucial factor in attaining the goals, Mulligan says.

“Once the patient has arrived, one team gets the room ready; one team gets the patient ready; yet another team member assists both — while another nurse transports the patient and dispenses medications,” he says.

“Our physicians on staff are dedicated to making this work,” says Ziegler. “The enthusiasm has been contagious from the doctors, to the staff, to the patients. Our average door-to-balloon time since the beginning of the year has remained consistently under 80 minutes.”

Rousis says once the process was modified, it heightened awareness as to where the windows of opportunity were for timesaving improvements.

This just proves that anything is possible when we all work together, says Rousis.