For Heart Attack Patients, Time is On Your Side at Danbury Hospital Award-winning Collaborative Initiative Benefits Regional Patient Care
Western Connecticut Health Network Receives Connecticut Hospital Association's 2013 John D. Thompson Award
Western Connecticut Health Network (WCHN) is proud to receive the prestigious 2013 John D. Thompson Award from the Connecticut Hospital Association, honoring the Network's seven-year initiative to improve the care and survival of patients with a severe type of heart attack, ST Elevation Myocardial Infarction (STEMI).
With heart attack patients every moment counts: a shorter time to intervention means an improved chance to survive. CHA cited the Network's effort to substantially reduce "door-to-balloon" time, the crucial period from when a STEMI patient arrives at the hospital, until the patient receives a potentially life-saving coronary artery balloon angioplasty and stent. Since 2011, every eligible STEMI patient arriving at Danbury Hospital in need of this procedure has experienced door-to-balloon time of less than the 90-minute goal recommended by the American Heart Association.
"This project reflects our organization's vision: to create an environment of continuous learning, discovery and innovation that will benefit the wellness of our patients," said WCHN President and CEO, John Murphy, MD. "And it speaks to our organization's value of teamwork - among our clinical departments and across our Network."
The Start: Moments Count
About 25 percent of the approximately 1,000,000 heart attacks in the U.S. each year are STEMI. "Shorter door-to-balloon times correlate directly with survival," says Dr. Hal Wasserman, Interventional Cardiologist at Danbury Hospital. "Our goal is to achieve the shortest door-to-balloon time possible."
In 2005, WCHN formed a team to improve door-to-balloon time, involving physician and nursing leadership from Cardiology, Laboratory Medicine and Emergency Medicine, the Performance Improvement team and Emergency Medical Services (EMS), and community agencies and donors.
For seven years, the team has recorded data at specific time points from the first patient encounter to when the artery was opened, then analyzed the data to identify where the process could be safely accelerated. "Part of our hospital's culture is to continuously improve quality, and door-to-balloon time is a key metric of quality," says Dr. Andrew Keller, Chief of Cardiovascular Services. "In this effort, we looked at how each minute is spent during the delivery of care."
In 2010, Danbury Hospital added a dedicated EKG (electrocardiogram) room in the Emergency Department for faster access and diagnosis. As a result, EKGs can be immediately done in the triage bay and STEMI alerts can be called when present. The hospital reconfigured the catheterization lab teams based on distance from the hospital to ensure timely preparation and adjusted the process for patient transport for catheterization.
The Gifts: Expanding Community Capabilities with the Donor Help
Heart attack patients arriving by ambulance typically have the shortest door-to-balloon times because EKGs can be performed in the field by emergency medical responders and hospital preparation for the patient begins even before arrival. More field EKG capability means more lives saved.
In 2009, WCHN received a gift from two community donors to provide 17 EMS programs within a 25-mile radius of Danbury Hospital with wireless modems to transmit 12-lead EKGs to a receiving station monitored by emergency physicians. Today some 90 EKGs are electronically transferred to the ED for review each month. This enables hospital staff to act more efficiently when a patient arrives.
The program's success hinges on the collaboration between hospital physicians, Emergency Department staff, and EMS teams throughout the surrounding towns. EMS providers are educated about the significance of door-to-balloon times, and their important role in initially evaluating patients. They are trained to recognize and treat cardiac emergencies and transmit the EKG en route to the hospital to increase the chance for patients to survive.
The Results: More Lives Saved
Since February 2011, 100% of eligible patients presenting with STEMI at any time of day have experienced door-to-balloon times of less than 90 minutes, according to Dr. Wasserman, outperforming the American Hospital Association guidelines. For STEMI patients arriving off-hours, door-to-balloon time has decreased over 23 minutes; for those arriving by ambulance, the time has been reduced by an average of more than 30 minutes.
Southbury resident Peter Frisbie directly benefited from this effort. He developed chest pain one morning last April, activated 911 and was transported by ambulance from his home to Danbury Hospital while having a heart attack. His EKG was performed in the ambulance. "It was clear the hospital was expecting me,” he remembers about his arrival. With a 32-minute door-to-balloon time, says Peter, "It's obvious there was efficiency built into the program." Peter is now on his way to a complete recovery with an excellent prognosis.
"The most important thing is to improve the quality of our patients' lives," says Pat Broderick, MD, Chair of Emergency Medicine at Danbury Hospital. "To get someone to the procedure they need in a defined period of time gives them the chance to enjoy the remainder of their life!"
The Future: Continued Collaboration
Dr. Thomas Koobatian, Chair of Emergency Medicine at New Milford Hospital, now leads the effort to reduce door-to-balloon time for heart attack patients in a wider geographic radius. Heart attack patients at New Milford Hospital are transferred to Danbury Hospital for coronary angioplasty. In 2011 New Milford Hospital began collecting data, including time in NMH and EMS transport time to Danbury Hospital.
Dr. Koobatian is working with ED Nurse Manager Ron Stephens and emergency medical services in the greater New Milford area, revising the Hospital's ED processes to reduce transfer time, and total door-to-balloon time, for patients presenting to NMH with cardiac symptoms.
About the Connecticut Hospital Association's John D. Thompson Award
The Connecticut Hospital Association John D. Thompson Award is a prestigious award recognizing excellence in the delivery of healthcare through the use of data. Since 1994, this award has been given to one hospital each year to honor the contributions made by John D. Thompson to healthcare administration and patient care quality during his career.
Recipients are selected based on how the hospital successfully improved patient care due to a modification in process as substantiated through the use of data. A five-member panel composed of representatives from various organizations with an interest in healthcare quality evaluates entries.
About Western Connecticut Health Network
Western Connecticut Health Network is the region's premier, patient-centered health care organization serving residents of Western Connecticut and adjacent New York. The organization is anchored by two nationally recognized hospitals, Danbury Hospital and New Milford Hospital, as well as their affiliated organizations. In addition to the two hospitals, the continuum of care offered includes the following affiliates:
- Western Connecticut Medical Group, an integrated physician practice with primary and specialty care expertise
- Western Connecticut Home Care, an agency for home care and community health services
- The Western Connecticut Health Network Foundations
- emergency medical and Level II trauma services
- an occupational wellness and medicine program, providing services for business and industry
- a nationally renowned Biomedical Research Institute
Western Connecticut Health Network has centers of excellence in women's health, cardiovascular and cancer services; minimally invasive joint and spine surgery; digestive disorders, weight-loss (bariatric) surgery, and radiology and diagnostic imaging. It also offers specialized programs for neonatology with a Level IIIb neonatal intensive care unit and accredited sleep disorder centers. Both hospitals also maintain active clinical research programs, offering clinical trials for patients with cancer and other health concerns. Danbury Hospital was named a Top 100 Hospital by US News and World reports in 2012; a and a Top 100 for Value by Cleverly and Associates. New Milford Hospital is well known as a Planetree hospital and for its Plow to Plate, farm to table food program.
For more information, visit WesternConnecticutHealthNetwork.org, DanburyHospital.org; NewMilfordHospital.org and share your comments with us at Facebook.com/DanburyHospital or Facebook.com/NewMilfordHospital.
Imagine Build Transform: The Campaign for Western Connecticut Health Network
Western Connecticut Health Network is conducting a capital campaign to meet patients' changing needs with next generation facilities, resources, talent, and technologies. Our priority areas are the Patient Tower, Emergency Department, and Neonatal Intensive Care Unit at Danbury Hospital, the Emergency Department at New Milford Hospital, and the Biomedical Research Institute. To learn more, please call the Foundation office at (203) 739-7227 or visit us at TheCampaignForWCTHN.org.