STEMI Means STAT at The Queen's Medical Center

Roy Hernando, RN and Genine Gorman, RN with a STEMI toolbox and STEMI Rx kit.

Heart attack patients have always been brought to the emergency room, but a new way of fast tracking them at The Queen's Medical Center can cut the death rate in half, with a 97% chance of survival, and can dramatically improve a person's quality of life after they leave the hospital.

The new program is called "D2B: An Alliance for Quality." Launched by the American College of Cardiology (ACC), D2B stands for Door to Balloon, and refers to an effort to get patients from the hospital door to a balloon angioplasty in 90 (median) minutes or less. The goal is to restore blood flow to the heart as quickly as possible to minimize heart muscle damage.

Queen's was the first in Hawaii to join the D2B Alliance. According to the ACC, studies have demonstrated a strong relationship between treatment time and in-hospital mortality risk. Time is muscle; a blockage in an artery leading to the heart causes tissue to die. Severe damage to the heart leads to congestive heart failure, which means that a person's poorly functioning heart does not effectively circulate blood throughout the body, making other conditions worse and necessitating a multitude of medications with their attendant side effects.

Typically, when a patient enters an emergency room with chest pain, it could take a cardiologist anywhere from 30 minutes to two hours to get to the ER. If the EKG indicated STEMI, the cardiologist would then send the patient to the Cath Lab for a percutaneous coronary intervention (PCI), or a balloon angioplasty and insertion of a stent to keep the artery open. STEMI is a medical acronym for an acute heart attack. (Segment Elevation Myocardial Infarction refers to a portion of a graphical readout from a 12-lead EKG that is elevated above normal, indicating a heart attack.)

Members of the Cath Lab Team.

With D2B, the ER doctor instead calls a STEMI after reading the EKG and immediately notifies Telecommunications at Queen's. Telecom pages every Cath Team member with one call and calls the Physicians Exchange, which pages the cardiologist. At the same time, ER staff, who have been trained to prep patients for the Cath Lab, start a 90-minute countdown timer on a D2B clipboard and grab a STEMI toolbox (containing Cath Lab supplies such as saline bags, IV supplies, a groin shave kit, consent forms and data sheets) and a STEMI Rx kit (a plastic bag with date-sensitive medical supplies). The toolbox and toolkit save time not only by having in one place items normally located in six to seven places, but also by prepping the patient before entry into the Cath Lab. Collaboration and coordination between physicians and multiple departments have enabled Queen's to give heart attack patients treatment faster than ever. Says Kapunahele Montgomery, RN, Operations Manager of the Cath Lab: "The bottom line is that patients benefit."