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November 19, 2011

W. Va. hospital aims for speedier response time

Charleston Daily Mail

CHARLESTON, W. Va. — Heart attack patients in Thomas Memorial Hospital's emergency room are treated, on average, within 67 minutes of arrival.

"This is 67 minutes in the daytime and the middle of the night," Bob Gray, senior vice president of business development, told hospital Board of Trustees members on Thursday.

Doctors at Thomas fix blocked arteries using angioplasties. A surgeon inflates a small balloon inside a patient's blocked artery to reopen it for blood flow. The surgeon then places a tube, called a stent, in the artery to prop it open.

At Thomas, the average patient's artery is reopened just over an hour after they arrive in the emergency room.

The hospital measures only door-to-balloon response times for emergency room patients experiencing an "ST segment elevation myocardial infarction," or STEMI. In laymen's terms, a STEMI is a heart attack where all blood is cut off to the heart.

Gray said some heart attack patients are stabilized before going into surgery. However, doctors don't want to wait long if they're dealing with a STEMI.

"When your heart muscle doesn't receive blood supply, the heart begins to die. Time is of the essence," he said.

The hospital has performed 29 STEMI procedures in the last 12 months.

Thomas' staff still is trying to treat patients faster, Gray said.

Catheter lab and emergency room staffers communicate regularly, trying to whittle their response times. One Thomas cardiologist recently had a patient's arteries reopened in 28 minutes, he said.

"We sit down every time and say what can we do better," Gray said. "Every one of these patients that come in here is somebody's daddy and somebody's mom, so we try to treat them this way."

Technologies also have helped speed up response times.

The Kanawha County Ambulance Authority's ambulances transmit echocardiograms - images depicting a patient's heart rhythm - to the hospital from the field.

That way, doctors can tell even before patients arrive whether they're experiencing a heart attack and what kind of heart attack it is.

"That gets the process started pretty quickly," he said.

If a patient already admitted to the hospital has a heart attack, nurses can send the patient's echocardiogram images to a cardiologist's smartphone.

"He can see that EKG strip right on his cellphone. They can see in the middle of the night what they're dealing with," Gray said.

Gray said the hospital also has put lab equipment in its emergency room, so patients' lab tests are performed faster.

"You draw it right there and you've got a machine right there. It speeds things up tremendously," he said.

Thomas Memorial doctors have been performing stent surgeries for only two and a half years.

Gray said Thomas doctors previously could put a catheter in a patient's heart but could not treat any disease or blockages they found.

"If you had disease and blockages, we had to send you to St. Francis," he said.

West Virginia changed its regulations about two and a half years ago to allow emergency rooms to perform emergency surgeries to install heart stents. Thomas had to wait two years before it was allowed to perform stent procedures on patients in non-emergency situations.

Gray said he could not provide door-to-balloon response times from when the hospital first began performing stent operations because he did not remember what those response times were.

Thomas' response times still are greater than the national average, however.

According to a recently published study in "Circulation," an American Heart Association journal, the median door-to-balloon response time in U.S. hospitals was 64 minutes in 2010.

That's down from 96 minutes nationwide in 2005.

The study included more than 300,000 patients in 900 U.S. hospitals who had emergency angioplasties. Only hospitals that receive Medicare reimbursements, such as Thomas, were included in the study.

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