Capital Medical Center

When Dan Baker awoke Dec. 8 at Providence St. Peter Hospital, it seemed as if it was only minutes since he was helping Chehalis River flood victims clean house. Thanks to a new effort to shorten intervention times for serious heart attacks, it was. When a person has a major attack requiring a catheter or slender tube be inserted to open arteries around the heart, a national standard calls for no more than 90 minutes to elapse from the time the patient arrives at the hospital until the procedure is started. Olympia’s two hospitals, St. Peter and Capital Medical Center, have programs to beat the national standard. St. Peter improved its time from an average of 94 minutes between July and December 2006 to an average of 53 minutes from mid-December 2007 to the end of April.” Capital Medical Center’s goal is 75 minutes. In the last reporting period the hospital had two “door-to-dilation” incidents. One met the 75-minute standard, the other met the 90-minute standard. “The sooner you can open up the arteries, the better the patients do,” said cardiologist Bill Gavin, medical director for St. Peter’s regional heart center.

Improvement Program
Gavin said stories such as Baker’s are an example of results for his team’s recent improvement program. Last year, the hospital assigned Alan Messegee to analyze the hospital’s door-to-dilation or “door-to-balloon” process and make the system more efficient. Messegee is a specialist in a methodical approach to improve operations called Six Sigma. At that time, the intervention process in a sample of 40 serious heart attack patients who came to Providence between July and December 2006 averaged 94 minutes. Messegee started his work in June and finished in mid-December. The post-program difference shows the improvement. From Dec. 14 to April 30, the team shortened its door-to-dilation time to an average of 53 minutes. “Time is muscle,” said Kurt Miller, director of the St. Peter heart center, referring to heart muscle that can die if deprived of blood and oxygen.

What changed
The key to the success, said Larry Fontanilla, a Providence emergency room physician, was “getting the patient out from under the eight-ball” at the front end of the process in the emergency room. That means that the cath lab team is activated the moment a person calls 9-1-1 no matter what time of day that might be. Another change is that each member of the team from the paramedics, to the dispatchers, to the physicians knows exactly what his or her role is and how the hand-offs work. The system functions more quickly since each leg of the process is clearly defined and confusion is eliminated. For example, the cath lab staff is alerted while paramedics are checking the status of the patient in the ambulance. As the staff members begin arriving, the paramedics phone in the results of their tests. When the ambulance arrives at the hospital, the patient is wheeled right into the cath lab, Fontanilla said. “You don’t want them walking around in the ER and waiting there with a crowd of others,” he said. Gavin said the lab is open 24 hours a day. Team members who are on call must arrive within 30 minutes of an emergency activation. “It’s easier for us here in Olympia because a lot of people live close to the hospital,” he said. “In Seattle, it might not be that easy because a lot of people live further out.” At Capital Medical, registered nurse Brith Grinnell, clinical coordinator of the cath lab, said her team has a goal to shorten the door-to-dilation time to an average of 75 minutes. Elisa Moylan, chief nursing officer, said the Capital Medical cath lab has fewer procedures to perform than at St. Peter, but the team is just as focused on efficiency. “People who live in Olympia should feel comfortable that both hospitals are taking this issue very seriously,” Moylan said. Keri Brenner covers Thurston County for The Olympian. She can be reached at 360-754-5435 or kbrenner@theolympian.com.