Premier Physician Testimonial: Bill Tucker, MD
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National Recognition for St. Rita’s Reduction in Door to Balloon Time
July 2, 2009
The aggressive efforts of St. Rita’s Medical Center’s outreach program, centering on STEMI diagnosis, has lead to a sustained drop in the Door to Balloon (D2B) time for patients at the Lima, Ohio facility.
An awareness building campaign and education program was started in 2004. It involved the community, EMS, and hospital providers. The benefit for the region’s patients has resulted in an average Door to Balloon time of 38 minutes. Well below the 90 minute national guideline. St. Rita’s arranged donations that have enabled the local EMS squads to have the capacity to perform and transmit 12 lead EKGs to the Emergency Department. The emergency physicians have been empowered to activate the Cath Lab team prior to patient arrival resulting in this dramatic improvement.
The accomplishments of The Cardiovascular team of St. Rita’s were recently recognized by the HealthCare Advisory Board’s Cardiovascular Round Table. The team consists of Premier Health Care Services’ Drs. William Tucker, Jeffrey Boulter, Todd Bell, Lawrence Kohn, Gary Poturalski, John Terpstra, David Toth, Jerry Voit and Erin Rinto who are St. Rita’s Emergency Medicine Department’s physicians. Working collaboratively with Drs. Rajjoub, Shaheen, Abdelbaki, Eastway, Azous and Wolery, Cardiologists for St. Rita’s, the program has recently been expanded to the next level. Emergency Physicians at Joint Township District Memorial Hospital in St. Mary’s, OH have now been included in the team. The emergency physicians at this nearby hospital have now been empowered to activate the SRMC Cath team from their Emergency Department! This regional approach has resulted in D2B times of less than 90 minutes from the time the patient presents to JTDMH to the time their artery is opened in the Cath Lab at SRMC!
“We are very proud of what we have accomplished. It has been a true team effort from the physicians involved, hospital administrators and pre-hospital personnel and pre-hospital educators. I would give special thanks and acknowledgement to the administrator in charge of the program, Mary Marker, and Brenda Snyder, our EMS coordinator. It is an excellent example of a regional approach to disease management,” said William Tucker, MD, FACEP, Medical Director Emergency Services.”
Door-to-balloon is a time measurement in emergency cardiac care (ECC), specifically in the treatment of ST segment elevation myocardial infarction (or STEMI). The interval starts with the patient’s arrival in the Emergency Department, and ends when a catheter guidewire crosses the culprit lesion in the Cardiac Cath Lab. Because of the adage that “time is muscle,” meaning that delays in treating a myocardial infarction increase the likelihood and amount of cardiac muscle damage due to localized hypoxia, the American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommend a door-to-balloon interval of no more than 90 minutes. Currently fewer than half of STEMI patients receive reperfusion with primary percutaneous coronary intervention within the guideline-recommended timeframe. It has become a core quality measure for the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
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