By Becky Wiese
Mike Cuppini is thankful for a broken wrist. His wife’s broken wrist, to be accurate. Just over a year ago, on December 11, 2012, Mike, then a 52-year-old systems analyst at State Farm, stayed home from work because he didn’t feel well. “I thought I had the flu,” says Cuppini. “I had stomach pain that just didn’t go away.”
When he started sweating profusely, Cuppini’s wife, Julie, a cardiac nurse who happened to be home due to a broken wrist, knew something was up, and it wasn’t the flu. “She called 911 right away when I started sweating,” he says. Cuppini himself still wasn’t convinced it was anything other than a bad case of whatever bug happened to be going around at the time. He admits to being a little embarrassed when the paramedics showed up.
When they hooked him up to a portable EKG (electrocardiogram, also ECG) machine, Cuppini realized just by watching their nonverbal communication as they read the strip that they didn’t think he had the flu. They suggested a visit to the ER — immediately. He became dizzy in the ambulance and passed out. Later he learned that he had to be shocked during the ride because his heart had stopped working properly.
When he came to the Advocate BroMenn Medical Center emergency department, he knew by the urgency of the people working that something was seriously wrong. He was immediately taken into the cath lab for a balloon angioplasty and a stent. As it turned out¸ Cuppini’s main artery to his heart was blocked. “They caught it just in time. They call that artery the ‘widow maker’— if it closes, you’re a goner,” he says.
“There’s a saying that ‘time is muscle’ when it comes to heart attacks,” explains Dr. Jim McCriskin of Advocate Medical Group – Cardiology and Pulmonology (formerly Illinois Heart and Lung Associates). When a blockage to the heart occurs, the blood flow is diminished or cut off, which means oxygenated blood can’t get to the heart. When heart muscle is deprived of oxygen for too long, the heart muscle weakens and the heart fails to function properly. This is commonly referred to as heart failure.
To minimize the effects of heart failure, medical personnel strive to decrease the amount of time it takes to diagnose and treat the problem — meaning getting the blood flowing to the heart muscle as quickly as possible. At an accredited Chest Pain Center such as BroMenn Medical Center, this process starts almost immediately through an integrated continuum of care as prescribed by the Society of Cardiovascular Patient Care (SCPC).
The Benefit of an Accredited Chest Pain Center
Mike Cuppini experienced firsthand the benefit of receiving treatment at an accredited Chest Pain Center. BroMenn Medical Center recently earned a three-year re-accreditation from the SCPC for being such a facility. The SCPC works to ensure that patients receive standardized, timely, and effective treatment of acute, as well as non-acute, cardiac events.
“To achieve accreditation,” explains Dr. McCriskin, “the emergency medical services, hospital, physicians, nurses, and other personnel must fulfill numerous criteria and demonstrate that all work together in a coordinated effort to provide the best possible outcome for patients experiencing chest pain and acute heart attacks.”
Elements in eight key areas are monitored and graded. Three elements have to do with the coordination of care from the moment a 911 call is placed until the patient is treated as needed in a catheterization (“cath”) lab or admitted to the Cardiovascular Care Unit (CVCU). Two additional elements have to do with ongoing improvements in the processes, quality of care, competencies and ongoing training of everyone associated with the Chest Pain Center. The remaining elements cover the commitment of the entire organization to maintaining the standards of accreditation, community education, and functional facility design.
The overall purpose and goal is to provide better, faster, more efficient, and effective care for patients who experience chest pain and heart attacks. “If the process is streamlined, efficient, and standardized, it takes the guesswork out of the equation,” explains Dr. McCriskin. And lives, like Mike Cuppini’s, are saved.
How the Process Works
Bev Glendon, RN, BSN, BroMenn Medical Center’s Chest Pain Center Coordinator and Cardiac Data and Quality Specialist, and Dr. McCriskin along with other physicians, hospital staff, 911 dispatch, and emergency medical services have worked diligently since 2008 to obtain and retain accreditation from SCPC. The hospital has undergone a rigorous evaluation regarding the ability to assess, diagnose, and treat potential heart attack patients.
One of the primary goals of the SCPC is to educate the public about early heart attack symptoms. Many symptoms are well-known heart attack precursors: pain down one or both arms, jaw pain, shortness of breath, and chest pressure, for example. Several others may not lend themselves so readily to urgent action: a feeling of fullness, nausea, fatigue, anxiety, and back pain.
Mike Cuppini’s “flu” fits right in with these symptoms, and the reason he was reluctant to call 911 becomes understandable. Not only did he exhibit different symptoms, he had no previous heart issues. But he did have a family history of heart issues, he hadn’t had a physical in several years, he lived a sedentary lifestyle, ate a poor diet, and was overweight. His advice now? “Call. Don’t wait, even if it’s embarrassing. It’s better to be safe than sorry.”
For the community education and outreach component, BroMenn Medical Center has an American Heart Association-approved Training Center that certifies instructors and trains over 6000 people per year in CPR, AED (Automated External Defibrillator) use, Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), and first aid. The hospital also provides the community with education about heart disease through other classes, screenings, programs, printed materials, and its website, advocatehealth.com/bromenn. They even sponsor a free automated blood pressure check station at Bloomington’s Eastland Mall.
Another element of SCPC accreditation includes integrating communication and effort between EMS (Emergency Medical Services) personnel, emergency department staff, physicians, nurses, and other pertinent personnel. “This was a challenge,” says Glendon, “simply because it was a change and there were so many people involved that had to be willing to evaluate procedures and make changes when change was warranted.”
Dr. McCriskin adds, “When the data started showing improved results for diagnosing and treating patients, as well as successful patient outcomes, the buy-in became easier to the point that, now, the integrated, interdisciplinary team works together as a well-oiled machine.”
Emergency Medical Services personnel represent the “first line” defense. They see the patient and determine whether to run an EKG. If the results confirm a heart attack, they immediately call the hospital with a “CODE STEMI,” an immediate alert to all appropriate personnel, including the cardiology interventional physician, nurse, radiology tech, and a tech who watches the various monitors during the procedure. (STEMI is ST Elevation Myocardial Infarction, where ST is a segment of the wave on an EKG.)
Upon arriving at the hospital, a CODE STEMI patient proceeds immediately to the cath lab, bypassing the ER, which saves time. In the cath lab, the patient usually undergoes a balloon angioplasty to put in a stent. The stent, a stainless steel spring, acts as a snowplow to open up the artery so that blood can flow through to oxygenate the heart muscle once again.
“Diagnosing a STEMI patient before arrival at the hospital makes a huge difference in timing,” says Glendon. When we measure door-to-balloon (D2B) time, a national metric of how long it takes to get the patient’s blood flowing again, our time was shortened by 18 minutes when EMS personnel started calling in CODE STEMI.” The national average goal is less than 90 minutes D2B; BroMenn Medical Center’s goal is 60 minutes or less and “our median time is 46 minutes.”
Some patients come to the ER on their own. When this happens, the triage receptionists know what symptoms to look for. “We say anything waist to chin, front to back gets an immediate EKG,” says Glendon. “Even if the patient is not having a heart attack, we feel it’s better to cast a wide net, especially since some heart attack victims — women, diabetic patients, and the elderly— often do not present with typical symptoms.” The door to EKG interpretation by the ER physician for someone who walks in the ER has a goal of 10 minutes.
The integrated continuum of care doesn’t end at the cath lab. A STEMI patient typically goes home in two to three days from the Cardiovascular Care Unit; even patients who are not heart attack victims may end up staying overnight for observation and further diagnosis.
Continuing the Cycle of Care
Once discharged, a STEMI patient goes through rehab, where they concentrate on lifestyle modifications such as exercise programs and healthy eating habits. Mike Cuppini has eliminated much of the fatty foods he used to eat on a regular basis — “cheeseburgers, fries, pizza,” and now exercises several times each week. Although he’s thankful for his hospital’s excellence in treating heart attack patients, his goal is to not “get back on the table” for treatment.
Advocate BroMenn Medical Center’s recent re-accreditation as a SCPC Chest Pain Center guarantees that patients like Mike will have access to great cardiac care. “We’re constantly setting goals and measuring outcomes,” says Glendon. Adds Dr. McCriskin, “We’re always looking for areas of improvement — we don’t want to become complacent.” They want to “sustain the gain” — because lives are saved when the right information is received and acted on in a timely manner by qualified, committed personnel.
In addition to being an accredited Chest Pain Center, Advocate BroMenn Medical Center in Normal has received national recognition from the American College of Cardiology and the American Heart Association for implementing a higher standard of cardiac care for heart patients. For more information about Advocate BroMenn Medical Center’s patient-centered cardiovascular services and clinical expertise, visit advocatehealth.com/bromenn/heart.
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