Every Second Counts: Bypassing the ER

Article Date: Apr 12, 2011

Imagine coming to the hospital for a heart attack – and going straight into the cath lab, barely seeing the inside of the emergency room.

Sounds a little strange, right?

But that’s exactly what happened in a recent case at Alegent Health Midlands Hospital – resulting in an incredible 26-minute door-to-balloon time for a Plattsmouth man (that’s less than 1/3 of the national goal of 90-minutes, for those of you keeping score).

“It was very exciting,” says Midlands EMS Coordinator Lisa Beacom. “The Plattsmouth squad ran an EKG in the field, recognized the STEMI [a severe heart attack in which the coronary artery is completely blocked by a blood clot] and called it in. So we got together and agreed that when we saw the EKG and it was in fact a STEMI, then we’d try bypassing the emergency department.”

“Everything worked seamlessly,” explains Julie Nichols, Coordinator for Invasive Cardiology at Midlands Hospital. “From the Plattsmouth squad running the EKG to Dr. Alarid reading it and confirming the diagnosis to Lisa Beacom coordinating with the cath lab, where Dr. Carstens was just getting another patient off the table. So when the squad arrived, the medics wheeled him straight into the cath lab.”

Of course, this achievement didn’t come out of the blue. The Midlands emergency department and cardiologists have been working towards this goal, along with local EMS teams, for some time.

“This is the future for Chest Pain Centers like us,” Lisa says. “We know that the Society of Chest Pain Centers is hoping that this is where we’re all going. But it was cool to actually see how it could really work here in our hospital.”

“There’s a mantra we use in cardiology that time is muscle,” says Alegent Health Clinic’s Jeff Carstens, M.D., the cardiologist on the case. “Every minute that passes could mean additional damage to the patient. That’s why each of our metro hospitals have worked so hard to streamline the process for effectively diagnosing and treating heart attacks in less time than ever before. Bypassing the emergency room is the next step.”

Moving forward, the team plans to flow chart the process in order to evaluate what they can do to improve each step of the way.

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