Saint Louis University Hospital’s current door-to-cath procedure time in the ER has set a new standard – on both state and national levels. In 2008*, the hospital’s door-to-cath procedure time was just under 73 minutes, earning an 88.6 percent compliance rating – far better than both Missouri (74 percent) and the national (74 percent) averages. As one of the only 24/7 primary coronary intervention centers in the area, these numbers are significant.
This success is the direct result of collaborative diligence over the course of the last few years. In 2004, the average door-to-cath procedure time in the hospital’s emergency room averaged nearly 225 minutes – much longer than the recommended national average of between 90 and 120 minutes. At that point, Michael Lim, MD, director of the cardiac catheterization lab at SLU Hospital, called on several of his colleagues to gather and collectively review the hospital’s current guidelines for evaluating and treating MI cases.
“Dr. Lim was integral in identifying these problems and revamping the MI guidelines that were in place,” says Laurie Byrne, MD, the medical director of the ER at SLU Hospital. “He was instrumental in getting everyone who’s involved in the door-to-cath procedure on board with implementing these necessary changes.”
The group evaluated which steps were unnecessary and essentially eliminated the middle man. They compared the EMS cases versus walk-ins, and decided to tweak the admitting process by putting a nurse up front to evaluate actual MI cases. This way, a potential MI patient who presents with signs of a heart attack is immediately sent for an EKG.
The group also focused on better preparing and educating the pre-hospital partners that transfer patients to SLU Hospital. Additionally, they recommended synching the atomic clocks in the ER and cath lab, which are used during the door-to-cath procedure. All of these measures significantly improved the hospital’s time, reducing it from 200 minutes to approximately 90.
The advisory group became the Acute Myocardial Infarction Committee, and includes Michael Lim, MD, Laurie Byrne, MD, and Helen Sandkuhl, RN, director of nursing, emergency services, along with various representatives from the ER nursing staff, cath lab, radiology, pharmacy and the SLU Hospital Quality team. The Committee continues to meet every month, reviewing cases and making further improvements to the process.
The Committee’s efforts and subsequent success haven’t gone unnoticed. Last year, Saint Louis University Hospital was recognized as a 2008 ‘Triple Crown Hospital’ for outstanding performance in the areas of coronary artery disease, heart failure and stroke, according to Get With the Guidelines℠ (GWTG), a hospital-based quality improvement program operated by the American Heart Association and the American Stroke Association.
SLU Hospital received two gold awards for outstanding, sustained performance in the areas of coronary artery disease and heart failure, operating in compliance with the GWTG quality measures for 24 consecutive months. The gold level is the highest award attainable. The Hospital also received the silver award for its stroke performance, operating in compliance with the GWTG quality measures for 12 consecutive months.