Crozer Receives Quality Achievement Award for STEMI Patient Care
Crozer-Chester Medical Center recently qualified for the American Heart Association’s Mission: Lifeline Bronze Quality Achievement Award. The award recognizes Crozer’s success in implementing evidence-based procedures for STEMI (ST Elevation Myocardial Infarction) patients that aim to improve survival rates and decrease complications.
Every year, almost 250,000 people experience the type of heart attack known as STEMI. Unfortunately, a significant number of people do not receive prompt reperfusion therapy, or the opening of their blocked coronary artery, which is critical in restoring blood flow to the heart. Mission: Lifeline seeks to save lives by closing the gaps that separate STEMI patients from timely access to appropriate treatments. Mission: Lifeline focuses on improving the system of care for these patients and, at the same time, improving care for all heart attack patients.
Hospitals that receive the Mission: Lifeline Bronze Performance Achievement Award have demonstrated that, for over 90 consecutive days, at least 85 percent of eligible STEMI patients (without contraindications) are treated within specific time frames upon entering the hospital and discharged following the American Heart Association’s recommended treatment guidelines. The Bronze award is a necessary step toward achieving the higher performance awards even if the higher award criterion is already met.
Providing the Right Care
Heart attacks are divided into two categories for purposes of determining the most appropriate treatment. Ancil Jones, M.D., chief of the Division of Cardiology at Crozer, explains the difference: “Heart attacks are divided into two types: STEMI (ST elevation myocardial infarction) and NSTEMI (non-ST elevation myocardial infarction). About one third of heart attacks are STEMI, and the balance are NSTEMI. The distinction is made by the pattern seen on the electrocardiogram (ECG).
“Physiologically, the difference is that the patient with STEMI usually has total 100 percent occlusion of the coronary artery causing the heart attack, and the NSTEMI patient generally has a severe occlusion, usually 70 to 99 percent, but not 100 percent of the coronary artery” continues Jones. “In a STEMI patient, the 100 percent occlusion means that the heart muscle is dying at a more accelerated rate than in the NSTEMI patient, and explaining the need for rapid action to restore blood flow, to stop ongoing damage, and to limit the size of the heart attack. That is the mechanism of better outcomes: smaller heart attacks, less heart muscle damage, better heart function after the event, and better overall outcomes.”
Crozer started the Percutaneous Coronary Intervention (PCI) program in 1992, along with coronary surgery, to treat STEMI patients more effectively.
“At that time, intravenous thrombolytic therapy, also known as ‘clot buster’ medication, was the most commonly used method for achieving reperfusion, which is the immediate restoration of blood flow to the heart in patients having the STEMI type of heart attack. We felt that the clinical data suggested that PCI was superior to intravenous thrombolytic therapy,” Jones says.
“From 1992 to the present, we have used PCI almost exclusively to treat these types of patients,” Jones says. “Subsequent medical studies indeed proved that when PCI is applied promptly to STEMI patients, outcomes in the form of lower death rates and fewer complications are superior to thrombolytic therapy. Since 1992, we have provided this care for approximately 1,500 such patients.”
The overall goals of the PCI program for STEMI patients are to produce better patient outcomes that result in a lower death rate; fewer complications, such as congestive heart failure; and better patient functional capacity after the event.
Providing effective and quick PCI therapy for STEMI patients is a team effort. The treatment typically involves non-invasive cardiologists, invasive or interventional cardiologists, emergency medicine physicians and nurses and EMS providers throughout the system.
“Even though this award goes out to Crozer-Chester Medical Center at the PCI facility in the system and through their participation in the Get With the Guidelines Action Registry, the honor is due in no small part to the work done by the EMS and emergency department staffs as well as the cardiologists at all of our hospitals that allowed Crozer to achieve this,” says Eileen Young, assistant vice president of Quality/Performance Improvement for Crozer-Keystone Health System.
“They all play a role in working together effectively in a timely manner to make the diagnosis, arrange for treatment, transport the patient to the Cardiac Catheterization Lab, and to take care of the patient after PCI treatment,” Young adds.
“We faced challenges at Crozer-Chester Medical Center and as a health system, in coming to a common vision of what was necessary and implementing the structure necessary to achieve and maintain goals with respect to time treatment,” Jones says. “We formed a system-wide Acute MI Task Force, which continues to meet regularly to oversee our program, review data and outcomes, ensure process and make improvements.”
The Quality Department at Crozer-Chester Medical Center plays a vital role in the implementation of the program and helps the medical practitioners meet the goals of the program.
“The Quality Department facilitates the AMI Task Force as well as other clinical care teams in the system to identify opportunities to standardize and improve care,” Young says. “We provided data feedback to the cardiac team. The goal with the program is quickly identifying the patients having a STEMI heart attack, activating the team and getting the patients to the cath lab quickly.”
Mission: Lifeline strives to improve care in both acute measures and discharge measures. Systems of care are developed that close the gap of timely access to appropriate, life-saving treatments. Before they are discharged, appropriate patients are started on aggressive risk-reduction therapies such as cholesterol-lowering drugs, aspirin, ACE inhibitors and beta-blockers in the hospital and receive smoking cessation counseling.
“Ultimately, we strive for decreased morbidity and mortality for patients,” Young says. “When it comes to treating heart attack patients, ‘time is muscle.' Any strides we make as a health system to improve the reliability of the evidence-based care we provide helps the immediate patient and every one that comes after.”
The STEMI program presents Crozer-Keystone Health System with many benefits and long-term improvement for patient care. “DelawareCounty residents will know that high quality and effective treatment for STEMI is available at each of our hospitals at all times,” Jones says. “We know that effective PCI treatment for STEMI reduces death rates, improves outcomes and also improves functional capacity for the patient after the heart attack.”
For more information about cardiac care at Crozer-Keystone hospitals, visit http://ckheart.crozerkeystone.org.