People experiencing acute heart attacks in Clark and Cowlitz counties are receiving treatment more quickly than they would have just two years ago.
An ongoing community collaboration headed by PeaceHealth Southwest Medical Center has been the difference.
“We’ve just had an incredible experience over the last two years,” said Dr. Aaron Schoenkerman, a cardiologist at The Vancouver Clinic and PeaceHealth Southwest Medical Center. “We’ve really made a lot of strides in the process.”
Two years ago, a person experiencing STEMI — or ST segment elevation myocardial infarction, an acute heart attack — would typically have had his or her blood flow restored within 72 minutes of walking through the hospital doors. Now, that happens within 60 minutes.
“It’s a marker for a system that’s really working for the community to have processes in place so a patient that lives in Clark and Cowlitz counties is getting sent to the right hospital and re-vascularized,” Schoenkerman said.
Collaboration
The standard of care for treating STEMI is a door-to-balloon time of 90 minutes or less. That means having a system in place to get 90 percent of patients re-vascularized — their artery opened with a balloon stent — within 90 minutes of their arrival at the hospital, Schoenkerman said.
“There’s pretty clear data, especially in patients with large myocardial infarction, that heart function and survival are improved if re-vascularization happens within 90 minutes,” he said.
For patients who show up at hospitals that aren’t equipped to perform stenting or angioplasty — such as Legacy Salmon Creek Medical Center and PeaceHealth St. Joseph Medical Center in Longview — the goal is to get the patient transferred to another facility where the surgery will be performed within 60 minutes.
Meeting those STEMI goals requires community collaboration, Schoenkerman said.
About two years ago, PeaceHealth Southwest door-to-balloon times were stuck in the 70-minute range. The hospital’s Heart and Vascular Center staff was concerned that the times weren’t improving, so they sat down with staff from various other departments — such as the emergency department, pharmacy and imaging — to brainstorm ways to improve, Schoenkerman said.
They discussed obstacles and policy changes that could make things smoother and offered ideas of new things to try, he said.
The hospital also turned to community partners — the referring hospitals, emergency services, dispatchers, pharmacists and medical providers — to streamline the process for treating STEMI patients, Schoenkerman said. The group continues to meet monthly to discuss cases and ways to improve times even more, he said.
“To me, the thing that makes me proud, is it’s such a multifaceted approach,” Schoenkerman said. “It’s about getting all the right people from all the right departments to troubleshoot potential problems.”
In order for the system to work, everyone needed to be on board and needed to understand their role in the process, Schoenkerman said. The pharmacists at referring hospitals needed to know which drugs to have stocked. The physicians at those hospitals had to be comfortable administering those drugs. The emergency rooms needed to have the appropriate people triage patients and make the call for transfer, he said.
At PeaceHealth Southwest, the emergency department staff needed to get patients in for EKGs — used to diagnose STEMI — quickly and have a system in place to call in physicians when the patients arrive in the middle of the night, Schoenkerman said.
The hospital’s 60 minute door-to-balloon time shows “how much the community and the different departments in the hospital have come together to build this program to improve the outcomes for heart attack patients,” he said.
‘So on it’
When Becky Brown of Vancouver walked into the PeaceHealth Southwest emergency department with heart attack symptoms in January, she was quickly ushered into a room for an EKG. Within minutes, Brown learned she was having an acute heart attack and the room filled with medical providers. One person was handing her nitroglycerin pills, while another was putting in IVs and administering other medications.
Brown, who was 46 years old at the time, called her son to explain what was happening. Then she was wheeled into the catheterization lab to have her artery, which was 100 percent blocked, opened.
“It was very scary, but they were so on it,” Brown said. “I was impressed. They were there for me.”
The day after the procedure, Brown felt great. Two weeks later, she had a stent put in another partially blocked artery. After the procedures, her energy levels increased, her fatigue lessened and her ambition returned.
“It has definitely improved my quality of life,” she said.
