April 24, 2009

Chest Pain Center granted accreditation

Chest Pain Center granted accreditation

Every year more than 5 million Americans come to hospitals complaining of chest pain. Some present with classic symptoms of a heart attack while others are more difficult to diagnose. Getting the atypical patients assessed and diagnosed quickly and to the cath lab for treatment in record time is setting Vanderbilt apart from other hospitals.

Vanderbilt Medical Center recently received full Cycle II with PCI accreditation from the Society of Chest Pain Centers for three years, placing it among providers offering optimal services — including 24-hour cath lab access and percutaneous intervention (PCI) — for the diagnosis and treatment of acute coronary syndromes.

“This process really helps to standardize the approach to chest pain and creates standards that are fairly strict that all hospitals must meet in order to obtain the accreditation,” said Keith Churchwell, M.D., executive medical director of the Vanderbilt Heart & Vascular Institute (VHVI). “When patients come into an accredited chest pain and PCI center they can feel comfortable that they are getting a level of care that meets these high standards.”

Collaboration among the Emergency Department, EMS, and VHVI has helped change the mindset about the treatment of chest pain. Everyone who comes in contact with patients recognizes that “time is muscle,” meaning that the faster a patient with chest pain is correctly diagnosed and treated the more cardiac muscle is saved. Such collaboration has led to exceptional door-to-balloon and EMS personnel-to-balloon times for treating one of the most severe forms of heart attack — ST elevation myocardial infarction (STEMI).

The American College of Cardiology recommends a door-to balloon-time of 90 minutes or less for 75 percent of heart attack victims. Vanderbilt’s median door-to-balloon time for all cases in 2008 was 60.5 minutes with 100 percent within 90 minutes. If the Nashville EMS brings a heart attack victim to the Emergency Department, the door-to-balloon time drops to 47 minutes. Only 20 percent of EMS systems provide field alerts, primarily by phone. The Nashville EMS transmits ECGs on all suspected heart attacks.

“We have become one of the most efficient STEMI receiving centers in the country,” said Corey Slovis, M.D., chair of the Department of Emergency Medicine and medical director of Metro Nashville EMS. “Our entire team has worked extremely hard to make this possible. From the time the 911 call is received until the patient leaves the cath lab, everyone works to minimize times and maximize results.

“Vanderbilt is one of those centers that doesn't miss subtle findings that represent an early heart attack. The art is recognizing people who don't come in with classic symptoms. Otherwise, it is impossible to have door-to-balloon and emergency personnel-to-balloon times like this consistently,” Slovis said.

There are eight key areas that a center must demonstrate in order to receive accreditation, including integrating the emergency department with the local emergency medical system; assessing, diagnosing and treating patients quickly; continually seeking to improve processes and procedures; having a functional design that promotes optimal patient care; and supporting community outreach programs that educate the public.

“It is extremely important to Vanderbilt to provide the best care possible for patients. The accreditation process provides us with the opportunity to measure ourselves and to make sure we are doing our best,” said Carol Parsons, R.N., M.S.N., Chest Pain Center coordinator.

The accreditation, good for three years, is an acknowledgement of the ongoing commitment to the process of improvement, added Parsons.

The Society of Chest Pain Centers has three goals: to reduce the mortality rate of chest pain patients through education; to reduce the time it takes to receive treatment; and to increase the accuracy and effectiveness of treatment.