Time is Muscle
In hospital-speak, a Code STEMI (or STsegment elevation myocardial infarction) signifies a serious type of heart attack in which a major artery leading to the heart is blocked. For a patient experiencing this kind of blockage, time is of the essence, or as cardiologists put it, “Time is muscle.”
“A heart attack happens because the artery has closed down and the muscle is deprived of blood flow and thereby deprived of oxygen,” said Pratik Desai, MD, cardiologist with WakeMed Physician Practices – Cary Cardiology. “Every second counts. Every second, the myocardial cells are dying, and once the cells die, they're replaced by scar tissue and the heart loses function. So the goal is to minimize the damage, and the way to do that is to reestablish the flow to the blocked artery as quickly as possible.”
The Code STEMI Wall of Fame, a bulletin board in the WakeMed Heart Center's Invasive Cardiology Department, lists the fastest "door-to-balloon" times.
For emergency technicians, emergency room physicians, cardiologists, the staff in WakeMed's 24/7 Cath Lab – the only one in North Carolina – and the rest of the Code STEMI response team at WakeMed, reestablishing blood flow as quickly as possible means making a coordinated effort to ensure the amount of time between a patient’s arrival at the Emergency Department and his treatment, called “door-to-balloon time,” is as short as possible.
“The coordinated chain of care is quite amazing,” said Brian Go, MD, cardiologist with WakeMed Physician Practices – Raleigh Cardiology. “The process starts with the excellent staff, with EMS and the emergency room and proceeds all the way through to Outpatient Cardiac Rehab. The patient transitions seamlessly (and sometimes very quickly) from one care team to another.
“A perfect example of teamwork is seen in the Cardiac Cath Lab. It is an honor to be part of such a team. It is an impressive sight to see how quickly and adeptly an experienced and dedicated cath team can work. WakeMed has also supplied the resources for optimal care, such as the excellent Cath Lab staff and helicopter transportation.”
In addition to maximizing the efficiency of the process and guaranteeing the resources necessary to provide excellent patient care, WakeMed also encourages a little healthy competition among care providers with its Code STEMI Wall of Fame. This “wall of fame” in the Cath Lab boasts about the shortest door-to-balloon times achieved.
“I’d be lying if I didn’t say that there is some component of pride,” said Dr. Go. “Anyone who works with us knows that we are a competitive group and have a healthy ego. However, we are very much aware that patient care comes first.”
Dr. Desai agreed: “We are humans, and we have the tendency to compete. The Wall of Fame allows us to implement and absorb good practices and get faster. The faster you do it, the better the outcome for the patient. If one of your colleagues can do it faster, then you want to do it that way too, or you want to beat his number.”
At the time of writing, Dr. Go and Dr. Desai are tied for the fastest door-to-balloon times on the Code STEMI Wall of Fame at 15 minutes for all of 2013/2014. This is significantly faster than the national average, which is 64.5 minutes, according to the American College of Cardiology’s National Cardiovascular Data Registry. At 43 minutes, WakeMed’s average door-to-balloon time is also well below the national average.
But, as Dr. Go said, time is not the only important factor, and he and all of the members of the care team recognize that sometimes the process itself is more important.
“I do take pride that for the past couple of years, I have accessed most patients with a STEMI through a radial (arm) artery, not through the groin,” said Dr. Go. “Recent studies indicate that in the setting of a STEMI, radial access may not only have benefit with decreased bleeding and hospital stay but also with mortality. Radial access is technically more challenging and can take a bit longer to prep, and it has taken me some time to get my STEMI times down to where they once were.”
In addition to minimizing door-toballoon times and ensuring the highest quality of care, WakeMed is also concentrating on the very beginning of the process, before the “door,” by helping to educate patients on the signs and symptoms of a heart attack and thus encouraging them to call 911 sooner.
“WakeMed has looked at every facet and has implemented best practices from all over the country,” said Dr. Desai. “In the process, we’ve become better than most other hospitals in the state and in the country. I’m part of the process, but the credit goes to everyone, no doubt.”
“I'd be lying if I didn’t say that there is some component of pride. … However, we are very much aware that patient care comes first.”
— Brian Go, MD
WakeMed cardiologist Brian Go, MD, reviews images of a patient's arteries to expedite diagnosis and treatment.