NEW ORLEANS -- Mayo Clinic has designed a new
system to speed critical care to acute heart attack
patients that
dramatically reduces the time that elapses before patients undergo a
life-saving procedure -- by as much as 45 percent in some cases.
This rapid response -- dubbed by Mayo Clinic as the FAST TRACK
protocol -- saves both heart muscle and patient lives. Mayo
researchers will report their results on March 26 at American
College of Cardiology’s 56th Annual Scientific Session
The most serious type of heart attack is known
as an ST-elevation myocardial infarction -- STEMI for short. In a
STEMI, critical arteries supplying the heart with blood are blocked.
Previous studies have shown that the best treatment for STEMI
patients is to open the blocked artery by inflating a balloon at the
blockage site within 90 minutes of arriving at a hospital that has
emergency angioplasty services. The 90-minute window is called
door-to-balloon time. The shorter the door-to-balloon time, the
greater the chance of survival, studies show.
In 2003, physicians at Mayo
Clinic recognized the urgent need to expedite care
for STEMI patients, says Henry Ting, M.D., the lead
author and a cardiologist at Mayo Clinic who
coordinates quality improvement efforts for
cardiology services.
At that time, patients with STEMI arriving at
Saint Marys Hospital on the Rochester Mayo Clinic campus had an
average door-to-balloon time of 98 minutes. Even more concerning is
the fact that STEMI patients who first reported to an outlying
regional community hospital and then transferred to Saint Marys
Hospital in Rochester had an average door-to-balloon time of 202
minutes.
"We knew we could do better -- and save more
lives in the process. And the tremendous team effort of caregivers
this required proved us right," Dr. Ting says. "Mayo’s new FAST
TRACK STEMI protocol dramatically reduced the time that elapsed from
hospital arrival to balloon procedure -- nearly halving the time in
the case of transfer patients arriving from regional hospitals to
Saint Marys Hospital."
The study shows that Mayo Clinic treated 597
consecutive patients from May 2004 to December 2006. Data were
logged for two patient groups: those presenting to the hospital in
Rochester and those who reported first to a regional hospital --
sometimes as much as 150 miles away -- and then transferred to Saint
Marys Hospital. For patients nearest Saint Marys Hospital, the
median door-to-balloon time was improved by almost 30 minutes,
decreasing by 31 percent, from 98 to 69 minutes. For farther-out
patients from one of the 28 regional community hospitals who
required transfer to Saint Marys Hospital, the median first
door-to-balloon time improved by almost 90 minutes -- a 45 percent
decrease, from 202 minutes to 116 minutes.
"In cardiac emergencies, time is heart muscle
-- the more treatment is delayed, the more the heart suffers," Dr.
Ting says. "This is why time is the most important tangible measure
of quality for caregivers to optimize in order to save more lives in
patients presenting with STEMI."
Mayo’s system of care to speed the process of
taking care of these critically ill heart patients includes these
key elements:
Single-call
instant alert to the care team. For patients arriving at Saint
Marys Hospital, emergency room physicians can directly activate
the catheterization lab team, without review of the case or
approval by a cardiologist, by calling a single automated phone
number that sends a simultaneous pager alert to all
catheterization staff who are on-call days, evenings, nights,
weekends and holidays.
Electrocardiogram within five minutes of arrival to the ER.
Patients with symptoms suggestive of heart attack who arrive at
Saint Marys Hospital or one of the 28 regional hospital
emergency departments in Minnesota, Iowa and Wisconsin receive
within five minutes an electrocardiogram, a test that quickly
identifies a STEMI.
Direct line of
communication to all care team principals. For patients arriving
at regional hospitals, emergency room physicians can call one
single phone number to speak immediately with an on-call
cardiologist and simultaneously activate the catheterization lab
staff and the air ambulance transport team at Saint Marys
Hospital.
Rapid loading
by air ambulance. The air ambulance transport team developed an
innovative "hot load" procedure where the helicopter engine is
left on and the time to pick up a patient from landing to
take-off is less than 10 minutes -- similar to a MASH unit.
24/7 readiness.
The Mayo system was designed to provide this expedited care to
achieve the best door-to-balloon time during regular hours -- as
well as during off-hours on weekdays, weekends and holidays.
Before 2004, there were several delays in care
of STEMI patients. These were due to processes for evaluation and
various procedures required to activate the catheterization lab, Dr.
Ting says. "These previous systems had been part of our health care
delivery system for several decades, and it really took a team
effort from highly committed physicians, nurses, technicians in the
emergency room, cardiology, cath lab staff and medical transport
crew members to redesign an entirely new system of care," he says.
"It’s been worth it, because we are delivering the best care --
opening a blocked artery -- faster and saving more lives. We also
are actively sharing our learning and innovations to improve the
system of care at all our hospitals in the Mayo System, including
Mayo Clinic Arizona, Mayo Clinic Jacksonville and Mayo Health
System, as well as collaborating with the American College of
Cardiology on the national door-to-balloon quality initiative. Our
solutions are simple and easy to disseminate and replicate for other
health care systems in the United States."
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