Tri-City focuses on speed of treatment for heart attack patients

By: PAUL SISSON - Staff Writer | Saturday, March 3, 2007 10:28 PM PST ∞

OCEANSIDE ---- Increasing a patient's chance of surviving a heart attack is not only about being skillful; it's also about being fast.

And speed is the watchword for Tri-City Medical Center's cardiovascular program, which announced this week that it has shaved 26 minutes off its average "door-to-balloon time" by adopting new techniques and deploying better technology.

The term door to balloon measures how long it takes a doctor to insert a tiny balloon into a patient's artery to clear away a blockage that is causing a heart attack. The clock starts ticking the minute a patient crosses the hospital's threshold and does not stop until the blockage is removed.

Time is important because evidence shows that quicker treatment means a greater chance of survival for heart attack patients.

Donald Dawkins, a hospital employee who administers Tri-City's cardiovascular programs, stressed last week that a few minutes can make all the difference.

"Every 30 minutes of delayed treatment increases the one-year mortality rate by 7.5 percent," Dawkins said.

The hospital is following the national lead in trying to decrease its door-to-balloon time.

Two of the nation's leading heart care organizations, the American Heart Association and the American College of Cardiologists, have made door-to-balloon time an important issue. Working together, the two organizations have released nationwide guidelines that call for heart attack patients with blocked arteries to have heart hardware inserted in 90 minutes or less.

Tri-City Medical Center said last week that new procedures and equipment it has put in place have helped its cardiovascular doctors, nurses and technicians decrease the average time it takes to unblock an artery from 112 minutes to 86 minutes, besting the national guideline by four minutes.

The most visible part of the hospital's drive to increase the speed of its heart attack response is a $50,000 investment ---- paid for by the Tri-City Healthcare Foundation ---- in new cellular communications equipment that can be linked to portable electrocardiogram machines installed in ambulances and firetrucks in Carlsbad, Oceanside and Vista.

Tri-City also installed special wireless receiving equipment in its emergency room so that the hand-held electrocardiogram machines used by paramedics in the field can transmit their readings back to the hospital.

A similar system was installed for inland North County by Palomar Pomerado Health in 2003.

An electrocardiogram uses electrical sensors placed on a patient's body to record his or her heartbeat. Doctors examine the machine's printout to determine whether a heart attack is under way. Patients with a blocked artery generally show a spike in their heart rate that shows up clearly on the heart monitor printout.

Until recently, paramedics had to call the results into the hospital. But now, with the new cellular transmission equipment, a digital copy of the cardiogram results can be transmitted directly to an emergency room doctor.

Dr. Kerry Mells, director of the Tri-City Emergency Medical Group, said Thursday that getting the cardiogram while the patient is still in the field is a key part of reducing the amount of time it takes to open an artery.

"If I get the (electrocardiogram) in the Emergency Department well before the patient arrives, I can, at that point, activate the cardiac catheterization team without even seeing the patient," Mells said.

The hospital's five-member cardiac team is on call 24 hours a day, and the hospital has modified its phone system so that Mells or another emergency room doctor can let everyone know they are needed by making one phone call instead of five.

Tweaking the system

The hospital says it has also worked to standardize paperwork and procedures in the emergency room to make sure that patients suffering from a blocked artery are recognized quickly. A new electrocardiogram machine was installed in the emergency room's main triage center to aid in early recognition of patients who drive themselves to the hospital rather than arriving by ambulance.

Alex Ramos of Vista was one of those who drove himself to the hospital three months ago when he began feeling pain that he knew needed attention.

"I started getting serious pains in my back, and it was radiating into my shoulder," Ramos, 55, said Thursday. "The nurse, once she found out that I already had one stent, she hooked me right up to an (electrocardiogram) and then they just whisked me right back to the operating room."

There in the hospital's catheterization lab, an X-ray showed that one of Ramos' arteries was blocked. A doctor then inserted a stent, a small wire mesh tube, to open the artery and allow blood to flow again.

"It's just so fast," Ramos said. "You can't believe how quick, and it doesn't even really hurt. I was awake for the whole thing."

Early effort

Tri-City wasn't the first hospital in the North County to turn to cellular technology to decrease its heart attack response times.

Palomar Pomerado Health, which operates public hospitals in Escondido and Poway, led the way in 2003 when it worked with inland fire departments to install similar cellular communications equipment in ambulances and firetrucks.

Palomar's efforts spawned a countywide effort to reduce door-to-balloon times. Hospital spokesman Andy Hoang said Palomar's average door-to-balloon time is currently 76 minutes.

Hoang said Friday that Palomar is currently focusing on getting patients to call 911 rather than driving themselves to the hospital. He said heart attack patients who arrive by ambulance stand a much greater chance of being treated in less than 90 minutes.

He said the hospital recently put together a "Dial, Don't Drive" campaign of TV and radio public service announcements aimed at getting the public to know heart attack symptoms and to call 911 immediately.

"The campaign has been funded by heart attack survivors, some who thought about or tried driving themselves to the hospital," Hoang said.

-- Contact staff writer Paul Sisson at (760) 901-4087 or psisson@nctimes.com.

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