Level One Patient Story
Shakopee, Minnesota—When Mark Preimesberger suffered from a heart attack, a fast-track treatment option called the level 1 heart attack program gave him the gift of time—and may have saved his life.
For heart attack victims such as Preimesberger, speed is everything. Spearheaded by doctors of the Minneapolis Heart Institute at Abbott Northwestern Hospital, the Level 1 heart attack program has grown into a partnership with nearly 30 hospitals across the state.
If treated quickly, heart attack patients have a much better chance of full recovery. Recent research also shows the benefits of a procedure called percutaneous coronary intervention (PCI), also known as coronary angioplasty, within 90 minutes of the onset of a heart attack. The treatment requires a catheterization lab, staffed by a team of highly-trained physicians and clinicians, and found in just one-third of all hospitals in the country, including Abbott Northwestern.
The Minneapolis Heart Institute’s Level 1 heart attack program at Abbott Northwestern has created a unique alliance allowing non-metro heart attack patients who fit established criteria a fast track to coronary angioplasty at Abbott Northwestern. The program depends on transportation working in harmony with proven medical procedures, but it all begins with quick decision-making by the emergency room physician at the community hospitals.
Heart Attack
It was an October afternoon when Preimesberger, an active 53-year-old, came home from work as a lawn care salesperson. He decided to work on his own lawn. He had been in good health, watched his cholesterol and had no family history of heart disease. But now he felt chest pains, tiredness and sweating. His wife, Holly, came home, recognized the symptoms of a heart attack and said, “You’re going right to the hospital.”
At St. Francis Regional Medical Center in Shakopee, the emergency department team quickly assessed his condition. He was having a heart attack.
A heart attack, or myocardial infarction, happens when obstruction stops the flow of blood to a particular part of the heart. Because St. Francis Regional Medical Center is a partner hospital with the Minneapolis Heart Institute at Abbott Northwestern, the attending emergency room doctor immediately initiated the Level 1 heart attack protocol.
The Level 1 Process
Communication is critical to the success of the Level 1 heart attack program. When the protocol is initiated, two cardiologists at Abbott Northwestern are informed. In fact, more than a dozen people are instantly notified around Abbott Northwestern, including the supervising nurse, charge nurse, the emergency room security guards – all of whom work together to get the patient to the cardiac catheterization lab as quickly as possible.
In the meantime, the emergency room professionals at the community hospital draw blood, take the patient’s medical history, and start the patient on drugs to reduce the risk of clot formation, and steady the heart rhythm, all in preparation for the angioplasty procedure. Staff at the community hospital staff work quickly and in a coordinated manner -- key to the success and the outcomes of the program.
"The protocol was built with input from all the people who really do the work,” said Barb Unger, RN, director of access for the Minneapolis Heart Institute at Abbott Northwestern. Emergency room nurses, paramedics from air and ground transportation, catheterization lab staff, and both non-metro and metro physicians all had input into the process. Reminder cards and posters are strategically placed around the partner hospitals to help remind of the protocol. Through extensive training and agreement, physicians and staff standardized the drugs and procedures needed at every point of the process. That standardization both speeds up the process and decreases the need for reports. Other staff members initiate the transportation to Abbott Northwestern. While being transported, the patient’s history and records are faxed directly to the catheterization lab where information is reviewed by Minneapolis Heart Institute cardiologists and staff.
A Team Approach
Although the science behind quick intervention has been well-understood, the ability to help patients without immediate access to the hospital has presented a huge barrier. Careful choreography between three enormous systems makes the protocol successful: the community hospital, emergency medical transportation services and the cardiac catheterization lab at Abbott Northwestern.
“One of the biggest players is our emergency medical system,” said Unger. “At the national level they said this could not be done because nobody can get all three players together. But that is absolutely what is happening.” Local and regional transportation systems like Life Link III, North Air and Allina Medical Transportation all received extensive training in the protocol while adding key insights. A total of three air services and seven ground ambulance services were trained in the protocol. “It doesn’t matter where you live,” said Unger. “You deserve the best treatment.”
By the time Preimesberger’s admitting procedure was complete at St. Francis Regional Medical Center, the helicopter was waiting. “You’re on a fast track,” Preimesberger remembers hearing from the air paramedic as they took him to the waiting helicopter.
Fast Track to the Catheterization Lab
Preimesberger’s flight from Shakopee to Minneapolis took just seven minutes. At the same time, volumes of his patient data were sent by fax to the Abbott Northwestern catheterization lab. Physicians and clinicians prepared for him, with the helicopter crew giving periodic updates on their estimated time of arrival. When moments away from the hospital, the flight crew’s call initiated another level of attention: the entire catheterization team assembled. For Level 1 patients arriving by ground ambulance, security guards wave the ambulances to the proper doors – after all, Abbott Northwestern is itself a small city with more than 42,000 patients in the hospital per year served by 5,300 employees and 1,600 physicians.
When Preimesberger arrived at Abbott Northwestern, the team of physicians and clinicians immediately began the balloon angioplasty procedure. The procedure is to insert a catheter through an artery until it reaches the blockage. The balloon is then expanded to crush the obstructing plaque against the wall of the artery, opening the artery again for blood flow. The team in the catheterization lab, led by Dr. Yale Wang, was able to complete the procedure, unblocking his artery within less than a half hour. The total time from arriving at the St. Francis Regional Medical Center Emergency Room to the unblocked artery: 67 minutes.
Impressive Results
The idea for the Level 1 heart attack program started with conversations between several Minneapolis Heart Institute cardiologists and emergency department physicians, especially doctors Scott Sharkey and Tim Henry and emergency room doctors Dave Larson and Lee Arostegui. They agreed the literature was convincing that angioplasty was effective over standard clot-busting drugs. Besides, patients who received the standard drugs were often brought in for angioplasty later.
“Angioplasty was a way to shorten a patient’s hospital stay and save health care dollars,” said Dr. Sharkey. “We’re delivering better care with less cost.”
Preimesberger is back at work today. In fact, he was back on his feet just days after the procedure. “My doctor called me a prodigy child.”
Feedback Loop
For both Abbott Northwestern and the partner hospitals, communication is an important part of the Level 1 heart attack program. After a Level 1 patient is treated, Abbott Northwestern phones the admitting emergency department to let them know the outcome. Abbott Northwestern and the partner hospital also track 12 points of data about each patient for comparison purposes. This information is used to constantly upgrade the protocol and challenge hospital staffs toward faster relief – an ongoing commitment to quality.
But for Preimesberger, the entire procedure happened so fast and with such precision. “Everything was so methodical,” he said. Minneapolis Heart Institute cardiologists agree. “I’m thrilled with how well the system has worked,” said Dr. Henry. “We’ve received outstanding cooperation from everyone.” |