WASHINGTON, D.C.—Alice K. Jacobs, MD, from Boston Medical Center, asked an expert panel how the cardiovascular community can best strategies to optimize door-to-balloon times for patients with ST-segment elevation myocardial infarction (STEMI)—either at the PCI center or the transfer center—at the Cardiovascular Research Technologies (CRT) on Feb. 27.
The panel responded accordingly:
Eric B. Bates, MD, University of Michigan Medical Center in Ann Arbor
"Establishing a system of care that includes ancillary services is integral. Hospitals must have protocols in place, and a multidisciplinary review committee needs to review their results and times on a monthly basis. In order to properly provide care in high-volume centers at a PCI-receiving center, the whole community needs to be on board with the protocols, which may require face-to-face meetings with referring facilities, a signed contract between all the parties and pre-hospital 12-lead ECG, as well as open communication pathways."
Timothy D. Henry, MD, Minneapolis Heart Institute
"While door-to-balloon times for STEMI patients are a marker for how a system works, it really needs to be much more than that. A standardized approach to MI treatment is critically important, which includes guideline-based medications on admission and discharge, plan for cardiac rehabilitation, as well as follow-up. All treatment has to be systematized, so all patients receive the same treatment.
"While we’ve done really well in PCI centers, we have not done so well in transfer centers. Every U.S. hospital should have a standardized plan for how they treat STEMI patients, including the transfer process as it needs to be a system-wide approach. Also, like Dr. Bates said, it is important that institutions assess their own quality results.
"Finally, you need supportive hospital administration, and a STEMI coordinator who is empowered to make the STEMI system work. Otherwise, it will not be an effective process."
Jonathan S. Reiner, MD, George Washington University Hospital in Washington, D.C.
"In additional to the comments of my colleagues on the panel, it is truly important that providers review every step, including the time points for every STEMI case in joint emergency department and cardiology department meetings. The ER department has to be present because that is often the point at which STEMI cases can be held up, if the patient is not diagnosed quickly enough. We review each case, in order to assess where we could have improved. It’s a continual quality improvement process.
"Three years ago, before we started our STEMI initiative, 50 percent of our patients had door-to-balloon times of less than 90 minutes. Last year, it was 80 percent, so all of these programs are important."
Lowell F. Satler, MD, Washington Hospital Center in Washington, D.C.
"It’s more than just a process for the hospital, instead, providers need to examine the region as a whole. Dr. Reiner’s group at GWU and our team at WHC, along with other providers in our network, are sharing one large database, which required time and dedication to overcome the legal and regulatory hurdles involved with sharing patient-protected information. All the sites are now faxing their information to a common coordinating data center. In about two months, we’ll have our first assessment of evaluating the entire system, based on this combined data collection effort. These data will provide a global perspective of a large, highly populated area, along with pointers for what individual providers can do to make transfer more efficient."