Patient Flow E-Newsletter
Volume 3, Issue 1
February/March 2007
Special Focus Issue-Improving Cardiac Care
In this Issue:
A note from the Urgent Matters Director, Bruce Siegel, M.D., M.P.H.- Best Practices: Code Heart: How Hospital Improvements in the ED are Reducing Time to PCI
- Innovations: Door-to-Balloon in 90 Minutes: North Carolina's RACE Approach
- Perspectives: When Affairs of the Heart Meet ED Crowding: A National Solution for Cardiac Patient Throughput
- In the News: New England Journal of Medicine Article on Myocardial Infarction Mortality Rates & the California ED Diversion Project Initial Findings
A note from the Urgent Matters Director, Bruce Siegel, M.D., M.P.H. 
This issue marks the beginning of the fourth year of the Urgent Matters newsletter. There is renewed energy in the push to solve ED crowding with the recent release of the Institute of Medicine reports on the Future of Emergency Care. Never have America's hospitals been more focused on improving patient flow. When this newsletter began, improving throughput in EDs and hospitals was a novel and untested idea. Today it is seen as a core element in providing care of the highest quality.
We are changing to meet these new realities. Given the explosion of information on patient flow, we will be taking a new approach with our newsletters. We will start special focus issues on topics such as improving cardiac care, pediatric emergency preparedness and employee and patient satisfaction. Our goal is to go "in-depth" and examine challenges to the provision of high-quality, timely emergency care in all its facets. We plan to highlight strategies ranging from individual hospital departments to statewide and regional collaborative projects that can alleviate the symptoms of ED crowding. As always we will seek to provide the most innovative strategies and their associated tools - our mission remains the same.
Bruce Siegel, MD, MPH
Director, Urgent Matters
Research Professor, The George Washington University
Washington, DC
Best Practices
Code Heart: How Hospital Improvements in the ED are Reducing Time to PCI
Hospitals are struggling to meet revised quality measures that call for heart attack patients to move from arrival in the emergency department to receipt of an angioplasty in just 90 minutes. Memorial Regional Hospital in Broward County, Florida, is making steady progress toward that goal with its Code Heart process. Code Heart requires a collaborative effort involving physicians and staff from the emergency department and the cardiac catheterization laboratory working in tandem.
Innovations
Door-to-Balloon in 90 Minutes: North Carolina's RACE Approach
With the new CMS door-to-balloon guidelines in place, hospitals are focused on improving throughput for cardiac patients. Duke University Medical Center recognized a key factor in delayed treatment was a poorly coordinated process to transfer patients from non-PCI hospitals to their catheterization lab. Processes focused on triage and transfers were modeled after trauma-based transfer systems across the United States. Based on success with their new protocols, the Duke model is now being used by regions across the state, including coordination between EMS, non-PCI hospitals and PCI hospitals.
Perspectives
When Affairs of the Heart Meet ED Crowding: A National Solution for Cardiac Patient Throughput
With an aging population and increased heart disease, already over-burdened emergency departments are frequently called upon to quickly usher acutely ill cardiac patients through a crowded ED into specialized cardiac units. University of Michigan Medical Center’s Dr. Brahmajee Nallamothu explains:
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Why the realities of America’s current health care system often do not result in timely treatment for ST-segment myocardial infarction, or STEMI, patients;
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Why he thinks that is unequivocally unacceptable; and
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Why STEMI regionalization may not be an easy remedy to implement, but why it’s likely the best solution.
In the News
New England Journal of Medicine Article
Higher Mortality Rates Associated with Myocardial Infarction Patients Who Are Admitted on Weekends
An article published in March of 2007 in the New England Journal of Medicine concluded that patients with myocardial infarction who are admitted to hospitals on weekends have higher mortality rates and a lesser likelihood of receiving invasive cardiac procedures. This increase in mortality could account for several thousand deaths annually in the United States. The article cites more appropriate staffing or regionalization of care for patients with acute myocardial infarction may prevent some of these deaths.
read more >>
California ED Diversion Project
Initial Findings from the California ED Diversion Project Show the Severity and Variability of Ambulance Diversion Statewide
The California HealthCare Foundation has funded the Abaris Group to assess ED diversion in California. Initial results from the first phase of the project indicate that California hospital EDs were closed to ambulances an average of 11 percent of the time in 2005. Four of the 31 EMS regions in the state were diverting ambulances up to 23 percent of the time, causing concern regarding the quality and timeliness of care as well as increasing EMS costs due to longer transport times. In the next phase of the project, the Abaris Group will identify best practices and successful strategies to minimize diversion.
read more >>
