D2B times at Parma Community General Hospital

Last week I was browsing around the D2B Alliance website and clicked on a section called Hospital D2B Stories. The very first listing was Parma Community General Hospital, Parma, OH – learn how PCGH achieved 85% of patients treated within the 90 minute goal. This caught my eye. It just so happens that I graduated from PCGH’s paramedic program in 1995.

Here are some highlights:

“[T]he hospital was struggling to achieve door-to-balloon times under 90 minutes (2004 average was 119 minutes). After identifying physician champions, the multidisciplinary Code STEMI team was identified and includes the ED physician and staff, on-call interventionalist, cath lab staff (including on-call), registered nurse and the surgical intensivist from the heart center, respiratory therapist, a lab phlebotomist and supervisor of the quality department.

“The hospital team at Parma Community committed to and implemented all of the D2B strategies (i.e., ED physician activation of the cath lab, one call activation, cath lab team ready in 20-30 minutes, prompt data feedback, senior management commitment and team-based approach) beginning January 1, 2006. Some additional procedures and strategies the hospital developed include designation of an on-call interventionalist and commitment from the clinical departments to provide staff on an immediate basis 24 hours per day. The hard work of the hospital team paid off as average D2B times decreased from 119 minutes in 2004 to 68.9 minutes in 2006 with 85% of patients treated within the 90 minute time goal.”

It goes on to explain some of the barriers they had to overcome to achieve these impressive results.

I have a confession to make. My first reaction to this success story was that the emergency medical services were conspicuously absent from the multidisciplinary Code STEMI team. In addition, it said that PCGH implemented all of the D2B strategies, but it didn’t list the optional strategy of activating the cardiac cath lab based on the prehospital 12 lead ECG.

A few days later, I chanced upon an article at Cath Lab Digest entitled Parma Hospital’s “Code STEMI” success story.

This article did mention EMS.

“The Code STEMI process continues to evolve and produce outstanding door-to-balloon times through effective partnerships and communication. The “Touch-and-Go STEMI” is a phrase that has been used to describe the process by which a patient is brought directly to the ED by the EMS squad for confirmation of the 12-lead ECG results by the ED physician, then is immediately transported to the cath lab (while still on the EMS stretcher). This method has allowed our center to achieve 15- and 16-minute door-to-balloon times.

“In a Touch-and-Go STEMI, the cath lab inherits many of the ED’s responsibilities such as blood draws and administration of medications. The Heart Center RN gathers data, including the patient’s name, height, weight and allergies. The hand-off is completed with direct communication between the ED physician and the cardiologist and the ED and cath lab nursing staff…”

“The Code STEMI process and performance measures are reviewed at committee meetings, and revisions to the process are implemented. Door-to-balloon time feedback is provided to the fire chiefs to share with the EMS squads to demonstrate how their actions in the field directly save heart muscle and improve patient outcomes…”

“Physician and nursing leaders have presented this striking data to local EMS departments to provide continuing education on the current guidelines and to reinforce that our center is the best in the area for treatment of STEMI patients…”

“Partnership with local EMS providers who have 12-lead ECG transmission equipment, utilization of a coordinated one-step notification process, and establishment of well-defined roles and performance measures with feedback have significantly improved door-to-balloon times at Parma Community General Hospital.”

I still had some questions, so I followed up with an email to PCGH. I was very impressed with the response I received! It turns out the communications specialist who received my email has a husband who is also a graduate of PCGH’s paramedic program. Now he’s an RN who works with STEMI patients in the Heart Center!

I also received an email from the data coordinator for cardiac services. Here’s what she had to say.

The ER receives a 12 lead EKG via cell phone transmission. The LikePak 20 [sic] is connected to the patient then to a cell phone and transmitted to our ER. The ER physician calls the Code STEMI (CS) team based on the 12 lead ekg (emphasis added). No cardiologist interpretation is necessary. The CS team assembles prior to the arrival of the patient to the ER. Upon arrival, the 12 lead ekg is confirmed by the ER physician, the patient is registered and taken immediately to the Cath Lab. On many occasions the patient has been met at the ER door by the cardiologist and the CS team which accounts for our 16 minute door to balloon times. Our process is the same day or night, weekdays or weekends or holidays. All area EMS systems are able to transmit 12 lead EKGs (emphasis added).

A Code STEMI poster is distributed to the depts usually within 24 hours of the event. The door to balloon time is noted and all of the staff in the ER, ED and our Heart Center are recognized. On a monthly basis, the fire chiefs of each surrounding community are emailed a report with the door to balloon times which includes all of the communities times. Our EMS coordinator is in regular contact with the communities and serves as a resource.”

That’s awesome! Congratulations to the Code STEMI team at Parma Community General Hospital!

I knew I came from good stock! :)

P.S. I emailed the Cath Lab Manger to ask about their rate of false positive activations, but so far I have not received a reply.

*** UPDATE 12/19/08 ***

To download a podcast with Parma Mayor Dean DePiero and Fire Chief John French, right click this link and select “save as”. Note: I had to download the file, right click it, and change the file extension to .mp4 in order to listen to the podcast with MS Media Player.



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EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

JEMS Talk: Google Hangout

Brooks Walsh MD
38 Year Old Male – Chest Pain and Leg Paralysis.
For sure, in severe chest pain you must consider PE! The vital signs and ecg did not, in this case, support that diagnosis, but patients don't always "read the textbook." Read the conclusion, see what you think!
2015-10-05 14:50:05
Joe Moore
38 Year Old Male – Chest Pain and Leg Paralysis.
I don't know the answer, but I'm going to put something into this discussion related to a pulmonary embolism. I've had one. The pain was "tearing, and 10/10 and radiating to the back. Pulse oximeter was 85, and 12-lead suggested ischemia. Fortunately, the local hospital was able to treat, but I spent one long night…
2015-10-05 13:58:56
“Bad heartburn” – 82 y.o. female without chest pain.
I would do a v4r to see if right side involvement as well as posterior v8-v9. Based on the pt not presenting hypotensive this can be RCA occlusion caused by disection of thoracic aortic aneurysm! Debakey type 1 aneurysm! No catch lab however surgical intervention would be required!
2015-10-01 16:47:29
“Bad heartburn” – 82 y.o. female without chest pain.
It's most likely a RVMI because the ischemia/infarction has effected the SA node. IWMI with bradycardia should highly suspect a RVMI. Not all RVMI's are preload dependant. Do a 15 lead ecg to verify V4R elevation. Have 2 IV's established with a bolus of at least 1L of fluid before giving nitrates. If the pt…
2015-10-01 08:55:01
“Bad heartburn” – 82 y.o. female without chest pain.
I kept feading this thread to see how long it'd take for someone to call it as it is 'inferioposterior MI' and the prize goes to iliyas on Sept 11.
2015-10-01 04:08:23

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