Northwest Memorial Improves Process For Treating Heart Attacks
Northwestern Medicine has reported dramatic gains in the treatment of an ST segment elevation myocardial infarction (STMI) more commonly known as the “widow maker” heart attack.
The Chicago-based healthcare system has reordered its priorities when treating the victims of STMIs at Northwestern Memorial Hospital in order to cut the time between inpatient admission and undergoing a balloon angioplasty. Clinical standard of care guidelines suggest that no more than 90 minutes should pass between admission and angioplasty, but studies suggest cutting the time to 60 minutes or less improves overall outcomes.
Northwestern Memorial convened a team that included emergency department and cardiac catheterization laboratory staff, as well as hospitalleadership to examine the problem. They applied a business concept known as failure mode, effects and criticalityanalysis to solve it.
"FMECA is a commonly used risk assessmenttechnique that has proven successful in high risk industriesincluding nuclear power and aviation," said Rahul Khare, M.D., assistant director ofoperations for Northwestern Memorial's emergency department and assistant professor of emergencymedicine at Northwestern University Feinberg School of Medicine. “We modified this technique to fit a clinical setting.Our team included everyone who would respond when a patient with a STEMI arrives at the hospital–emergency physicians and nurses, EKG technicians, and the entire cath lab team from cardiologists tonurses, and even the secretary who answers the phone and takes the patient's information.”
The group identified 12 high-risk steps that are involved in moving a STEMI patient to a balloon angioplasty. Among them: Ensuring that electrocardiograms are undertaken while the patient's vital signs are being recorded.
As a result, Northwestern Memorial was able to reduce the time to balloon angioplasty by about 20 minutes, officials said, with even better results reported during traditional down times such as nights and weekends. No official outcome data for STEMI patients under the new initiative was immediately available.
"With the emergency department and cardiac catheterization teams working together to identify areas for improvement, we now consistently achieve door-to-balloontimes that far exceed the national benchmarks for heart attack care,” said Mark J. Ricciardi, M.D., director of cardiac catheterization and interventional cardiology at Northwestern Memorial and associateprofessor of cardiology at the Feinberg School.
