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Four Emory hospitals achieve AHA recognition for heart attack care

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Janet Christenbury

Experts say victims of heart attacks have better outcomes with rapid intervention to open and unclog their blocked arteries. Now a new program at Emory Healthcare, shepherded by the American Heart Association (AHA), is proving just that.

All four participating Emory hospitals — Emory University Hospital (EUH), Emory University Hospital Midtown (EUHM), Emory Johns Creek Hospital (EJCH) and Saint Joseph’s Hospital, as well as affiliated Southern Regional Medical Center — have received the American Heart Association Mission: Lifeline Bronze Recognition award for achieving high standards in STEMI (ST-elevation myocardial infarction) heart attack care for 2012.

A STEMI heart attack is caused when a blood clot suddenly forms, completely blocking an artery in the heart. This can result in damage that covers a large area of the heart and extends deep into the heart muscle. Because of its severity, the priority in treating a STEMI heart attack is to open the artery as quickly as possible, saving as much heart muscle as possible. Treatment options consist of percutaneous coronary intervention (PCI), which includes both angioplasty and stenting; clot-busting medication; and coronary artery bypass graft surgery (CABG).

The goal of the new program is to get patients from their location in the community to the cath lab within 90 minutes of first medical contact. Since EMS providers are often the first medical responders to reach a heart attack victim, the protocol calls for EMS workers to do an electrocardiogram (ECG) in the field to look for signs of a STEMI heart attack. Then they contact a participating hospital’s emergency room with results, or transmit the ECG for an emergency room doctor to read.

"Our goal is the get patients to the right place in the shortest amount of time to get treatment," says Michael Ross, MD, professor of emergency medicine at Emory and co-chair of the Atlanta Mission: Lifeline Program. "We believe that starting this process in the field, upon first medical contact, helps us to minimize the severity of the heart attack. Then we can prepare for the patient’s arrival by quickly activating the cath lab to unblock the artery."

During three consecutive months of 2012 (one quarter of the year), all four Emory hospitals achieved at least a 75 percent success rate in the "First Medical Contact to Balloon time within 90 minutes" performance measure for STEMI patients. This earned each hospital a Mission: Lifeline Bronze Recognition award.

Emory hospitals, like many other hospitals, have long participated in the "Door to Balloon time within 90 minutes" performance measure for STEMIs. This means having the patient’s blocked artery opened within 90 minutes of their arrival at the emergency department. Since Emory was hitting this target nearly 100% of the time, the team decided that wasn’t good enough. For patients coming in by ambulance they decided to raise the bar by starting the clock at time of "first medical contact" in the community with the paramedics, instead of when they arrived at the hospital’s doorstep.

"We thought the clock needed to start ticking when EMS arrived and assessed the patient in the field for a STEMI," says Abhinav Goyal, MD, MHS, associate professor of medicine in the Division of Cardiology at Emory, and director of quality for cardiology at EUH and EUHM. "Therefore, we began re-working the process with the AHA, making sure that EMS vehicles were equipped with ECG machines and all EMS personnel were trained to obtain and interpret field ECGs." Goyal is also co-chair of the Atlanta Mission: Lifeline Data Quality Subcommittee.

"It took about three years for Emory hospitals to achieve a 95 percent success rate in the Door-to-Balloon metric when we committed to it seven to eight years ago," explains Ross. "But our successes came much quicker with the new First Medical Contact to Balloon performance measure. This is a true testament to the dedication and commitment of the Emory Healthcare system."

Both EUH and EUHM are accredited as Chest Pain Centers by the Society of Chest Pain Centers, now called the Society of Cardiovascular Patient Care.

"We are proud of our accomplishments, and we know they lead to the best quality of care for our patients and their families," says Goyal.

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