Charles Fenstermaker: Door-to-Balloon Time
When he attended a German dance at the Edelweiss Club last February, Charles Fenstermaker never dreamed his life would depend on such a quaint-sounding phrase. Fortunately, the team at Good Samaritan Hospital did.
Door-to-balloon time refers to the time between a heart attack victim’s arrival at the hospital and the opening of a blocked artery with an angioplasty balloon. Patients who receive prompt treatment are more likely to survive a specific type of heart attack. At Good Samaritan Hospital, improving that time is a priority.
Thanks to collaboration among clinicians throughout the hospital and emergency responders in the field, Good Samaritan has honed a process that has shaved precious minutes from its door-to-balloon times. It consistently surpasses the American College of Cardiology’s recommendation that hospitals speed those patients to treatment within 90 minutes or less, at least 75 percent of the time.
“Fewer than 40 percent of hospitals nationwide are getting door-to-balloon times done within that 90-minute window,” says George Broderick, MD, medical director of cardiology at Good Samaritan Hospital. “We’re routinely beating that benchmark and that’s critical because time is muscle,” meaning that quick response times can preserve more heart muscle function.
To improve its door-to-balloon times, Good Samaritan gathered a team representing every area that might have contact with a heart attack patient. The team pored over six months of data to identify trends and, more importantly, opportunities to improve, says Melissa Hodges, RN, MS, CNS, an advanced practice nurse who managed the project. “We looked at everything we were doing and asked ourselves, ‘Can we do better?’”
They did. Now, as soon as an EMS crew notifies the hospital that it is bringing in a heart attack patient, the Emergency Department physician alerts the cardiac catheterization lab and the interventional cardiologist.
Inside the hospital, they looked for ways to speed the process. By having Emergency Department physicians evaluate patients in the hallway and, when possible, send them directly to the cath lab, “We’ve been able to shave minutes from the process,” says Richard Garrison, MD, medical director, Emergency Department.
The design of Good Samaritan’s new heart facility has likewise contributed to the improvement. Because the Emergency department and cath lab are located on the same floor, patients get to their destination faster.
For patients like Charles Fenstermaker, whose door-to-balloon time was just 71 minutes, all these improvements translate to a better outcome. Three days after suffering his heart attack, he was back home. A month later, he was on the dance floor. “I can’t think of the words to describe the care I received,” he said. “Great, outstanding, terrific. From the EMS squad to the Emergency Department to the cath lab and the intensive care unit, everybody was amazing. It was a marvelous experience.”