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A Race Against Time
A team at Johns Hopkins Bayview has put emergency balloon angioplasty on a fast track.

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Jeffrey Trost led the effort to shorten cardiac arrest response time.

The air hissed from Leroy Harris, like a tire going flat. “I just can’t catch a breath,” he told the EMS technician kneeling in his living room.

The tech eyed an EKG readout and immediately called Johns Hopkins Bayview Medical Center. “You’re having a heart attack, Mr. Harris,” he said. The elevated peaks on the EKG indicated that Harris most likely needed an emergency balloon angioplasty to open up a clogged artery and restore blood flow and oxygen to his heart.

Thanks to Bayview’s new treatment goals for angioplasty patients, the retired Bethlehem Steel worker received his procedure in record time. Within 58 minutes, a balloon was rapidly inflated in his artery, pushing back problematic plaque. “When I rolled in the door, there was a team waiting for me,” recalls Harris.

Just two years ago, the scene would have been different. Back then, EMS teams didn’t have the authority to call Bayview into action. No specialized greeters graced the door. Hours could pass before the angioplasty began, earning Bayview frequent dings from the state of Maryland. Code of Maryland regulations require that 80 percent of patients needing balloon angioplasty be treated within two hours. Back then, the medical center could only pull it off 30 percent of the time. The program itself was in a kind of arrest, and the state was ready to stop all support. It gave Bayview six months to shape up, or be shut down.

“Our biggest problem was that many of our on-call staff lived beyond 30 minutes of the hospital,” says Jeffrey Trost, director of interventional cardiology and the cardiac catheterization lab at Bayview. When Trost was hired in 2005, he was charged with fixing the problem.

Without adding more people, more hours or more money, he and a team of administrators, physicians, nurses, technologists and clinical engineers found two solutions to treat Bayview’s ailing response times.

First, the hospital encouraged EMS teams, newly armed with 12-lead EKG machines, to make an initial diagnosis in the field, allowing Bayview to get a head start before the patient arrived at the hospital.

Second, the Cardiac Cath Lab Bridge Team formed, composed of a critical care nurse, a physician and a radiation technologist who preps the cath lab, like the one who artfully prepared for Mr. Harris’s arrival.

The entire team volunteered to take on the extra duties and cross-trained to be able to assist with the actual angioplasty, says Michael Cole, administrator of Bayview’s Division of Cardiology. That way, the balloon procedure begins as soon as the cardiologist arrives, even if the others are still traveling to the hospital. Because balloon cases can take 30 minutes to two hours, the Bridge Team stands in only as long as needed, then members return swiftly to their regular duties.

Cole says the new strategy can save a half hour or more and that a few minutes can make a difference in the patient’s outcome. “The longer an artery is occluded, the more the heart muscle is in jeopardy,” adds Trost, “and the less likely the patient will survive.”

The hospital’s turnaround has been so significant that it is no longer under reprimand from the state, and its concepts are being tested at Hopkins’ East Baltimore campus and at Howard County General Hospital.

Meanwhile, the team has new goals: to get 80 percent of patients from the emergency room doors to a balloon procedure in under 90 minutes. That’s something that only the top 10 percent of hospitals around the country can do, says Trost.

Mr. Harris already places Bayview among the best. “I wouldn’t be talking to you today,” he says, “if I went somewhere else.”                       


—Michele McFarland

 

 

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