Austin hospitals plan cardiac care changes

[Guest guest]

FYI, from the Austin American-Statesman

-Wes Ogilvie, MPA, JD, EMT

Austin, Texas

St. 's hospitals plan to treat heart attacks faster

New policy will save lives, hospital officials say

By _ Ann Roser_ (mailto:maroser@...)

AMERICAN-STATESMAN STAFF

Wednesday, February 23, 2005

ST. DAVID'S HOSPITALS — taking the adage, " time is muscle, " to heart — are

putting new procedures in place to treat heart attacks faster than they do

now.

The procedures are designed to start in the field with paramedics and

continue in the emergency room so that patients are seen more quickly by

cardiologists who can bust the clot causing the heart attack.

Instead of calling in the cardiac team after the patient arrives at the

hospital on nights and weekends — when the team has left for the day — the

emergency room doctor will summon them after being notified by paramedics in the

field. Right now, the teams generally aren't called in until after the patients

arrive at the hospital and are evaluated by the emergency room doctor.

The trip to the hospital takes an average of 20 to 25 minutes, said Dr. Steve

Berkowitz, chief medical officer of the St. 's HealthCare Partnership,

which operates three hospitals in Austin and one in Round Rock.

" Every minute that goes on is one more minute that the heart muscle can be

damaged, " Berkowitz said. " If we can shave those minutes off . . . we will save

lives. "

The gold standard for treating heart attacks is a balloon angioplasty to

restore blood flow to the blocked artery, which is causing the attack. Often,

the cardiologist leaves a stent in place to maintain the opened artery.

Those procedures require the use of a cardiac catheterization lab and a team

that's under the direction of a cardiologist.

St. 's also plans to have a blood-testing machine brought into the

emergency room so that cardiac enzymes can be tested immediately, saving more

minutes, Berkowitz said.

The new procedures will be in place at the four hospitals (North Austin

Medical Center, Round Rock Medical Center, St. 's Medical Center and South

Austin Hospital) by the end of March, he said.

The Heart Hospital of Austin used to bring in a team based on reports from

paramedics and doctors from hospitals in other counties when patients were

flown in by helicopter, but it abandoned the practice, said Dr.

Pederson,

an interventional cardiologist at the hospital. Too many patients turned out

not to be having heart attacks and it was too expensive to call in a team,

then send them home again. Plus, people got burned out by the number of false

alarms, he said.

" That's a fine approach, but I don't think most places that have tried it

have done it for very long, " Pederson said.

The Seton Healthcare Network, which operates three Austin hospitals with

cardiac catheterization lab (Seton Medical Center, Brackenridge Hospital and

Children's Hospital of Austin) in Austin, will sometimes call in a cardiac team

before the patient arrives at the hospital, if the emergency room physician

thinks it is necessary. Dr. Watkins, medical director of cardiology for

network, said he didn't know how often that happened.

Berkowitz said St. 's studied protocols around the country and found

that hospitals with established programs have been successful. He did not have

data, but a cardiologist at St. 's South Austin Hospital said that

studies show that patients who get treatment quicker have a better outcome than

those who don't.

Cardiologist Dr. Tucker cited data showing that a patient who gets a

balloon angioplasty within three hours is 1.6 times more likely to die than a

patient who gets one within an hour.