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.