PINEHURST – Heart attacks occur when blood flow stops to parts of the heart. The sooner a blocked artery (or arteries) can be reopened and adequate blood supply can be restored, the more likely that the person having the heart attack will survive and do well.
The heart care team at FirstHealth Moore Regional Hospital does a very good job of reopening blocked arteries, a fact acknowledged by Moore Regional’s recognition by BetterDoctor as one of the nation’s best hospitals for emergency heart attack care.
A consumer health site, BetterDoctor helps patients find the best doctors while also producing health studies that give consumers the latest information in health trends. The recent study on heart attack care was designed to help patients make better decisions about where to seek care.
With its seventh-place ranking, Moore Regional was the highest-ranked hospital in North Carolina. Moses H. Cone Memorial in Greensboro was ranked ninth.
According to BetterDoctor information, “If you live near one of the hospitals on our list, you can feel good that you’d be receiving top care if you ever needed it. Many hospitals that did not make the top results are also very adept at treating heart attacks. However, according to our measures from Medicare data, the ones we have listed stood out as the most high-performing in their treatment of heart attacks.”
The BetterDoctor study used the information from Medicare to compare the nation’s hospitals across six categories: aspirin at arrival, time to an electrocardiogram, the number of patients receiving primary PCI intervention (such as angioplasty, stenting or atherectomy) within 90 minutes of arrival, door-to-diagnostic evaluation time, 30-day mortality rate from heart attacks and 30-day readmission rate for heart attack patients.
As medical director for FirstHealth’s Regional EMS System, Matthew Harmody, M.D., oversees FirstHealth’s participation in the RACE line alert system, a statewide effort to improve heart attack care by increasing the rate and speed at which blood flow can be restored to blocked arteries.
“The goal is to get the patient to the Cath Lab and get the blockage opened up as soon as possible,” Dr. Harmody says. “Usually, there is adequate time for the team to get mobilized so everyone is waiting for the patient at (hospital) arrival.”
Paramedics in the FirstHealth Regional EMS System and Moore County EMS, as well as other EMS programs in the Sandhills region, are trained to call what is known as a STEMI alert when they identify (with a reading from a 12-lead EKG) the complete blockage of at least one coronary artery in a patient with heart attack symptoms. By calling FirstHealth’s FirstComm telecommunications center, the paramedics start a communications process that alerts a physician in the Emergency Department at Moore Regional Hospital and often the interventional cardiologist on call as well.
The paramedics transmit the EKG from the ambulance to an Emergency Department computer and sometimes to the cardiologist’s smartphone. If a physician review confirms the STEMI (and it usually does since FirstHealth paramedics have a very good record of recognizing STEMI signs), members of the Cath Lab team are alerted and mobilized – either from within the hospital during hours or by page if after-hours.
“There are several checks and balances in the system to make sure we are getting the right patients to the Cath Lab as efficiently as possible,” Dr. Harmody says.
This can include the electronic review of the medical records of patients with a known history of heart disease.
Each step in the RACE alert occurs as the patient is being transported to the hospital – often while bypassing smaller facilities without a Cath Lab. Moore Regional is the established PCI (percutaneous coronary intervention) Center for Moore, Montgomery, Lee, Scotland and Richmond counties as well as for portions of upstate South Carolina and Hoke, Randolph and Chatham counties and for some Womack Army Medical Center patients.
The three other FirstHealth hospitals can also figure in the STEMI process, usually with patients who get themselves to the emergency department.
“We have been a team player for these scenarios for several years as we want EMS to get those patients to the Cath Lab fast,” says Beth Walker, president of Montgomery Memorial Hospital. “Sometimes, the STEMI actually gets initiated in our ED for ‘walk-in’ heart attack patients. Our ED team knows the clock is ticking, and we have a process for getting those patients on the road to Moore Regional quickly.”
Moore Regional RACE coordinator Gloria Walters, R.N., characterizes the STEMI process as a “one-stop call” aimed at a goal of “90 minutes from door to device” or 90 minutes from the time the patient gets to the Cath Lab until his/her blockage is reopened.
“We thought that this was going to be impossible,” Walters says, “but we’re making it all the time.”
As quality coordinator for Moore Regional’s Cath Lab, Debbie Parker, R.N., receives patient data about every STEMI call. It’s her job to track the information and provide feedback to members of the STEMI team in reports that start within 24 hours of the initial alert.
Parker is also involved in quarterly RACE meetings in which team members assess successes and troubleshoot missed opportunities.
According to Parker, Moore Regional had 17 STEMI calls during July and met the 90-minute door-to-device goal every time.
“The faster you can get them to the Cath Lab and get the (blockage reopened), the better,” she says.
Interventional cardiologist Peter L. Duffy, M.D., of FirstHealth Cardiology, credits Moore Regional’s STEMI success – and the BetterDoctor recognition – to team effort. He calls the participating cardiologist “the beneficiary of the efforts of our EMS and ED colleagues to get the patient to us as quickly as possible.”
“Our patients are the ultimate beneficiaries of the program’s success,” he says, “and this comes down to the set-up of a process long before the cardiologist gets involved. The focus is on the door-to-balloon time, and the cardiologist can only control the Cath Lab-to-balloon time. It’s whether patients get to the Cath Lab in time, and that’s due to the EMS and ED people.”