Cardiac Cath Lab Becomes Model of Improvement
In recent years, the UNM Division of Cardiology has made significant progress in improving its services. These efforts are now receiving national attention.
Earlier this year, UNM Hospital and the Division of Cardiology received bronze awards for coronary disease and heart failure performance improvement from the American Heart Association (AHA). The awards are part of the AHA’s “Get with the Guidelines” program designed to improve outcomes for patients with coronary disease, heart failure and stroke.
Improvements within Cardiology can also be seen in the Cardiac Catheterization Laboratory. The Cath Lab provides all modes of invasive and interventional cardiac procedures and operates 24 hours a day, seven days a week.
One of the many important procedures performed in the Cath Lab is primary angioplasty, in which a balloon is used to open a blocked coronary artery, restoring blood flow to the heart to treat an acute myocardial infarction or heart attack. According to Mark Ricciardi, MD, Medical Director of the UNM Cath Lab, the Lab has made significant improvements in the amount of time it takes for a patient to receive primary angioplasty once they arrive in the emergency department (the so-called ‘door to balloon’ time).
“When treating heart attacks—we abide by the ‘time is muscle’ concept. The sooner we provide definitive treatment, the more heart muscle is salvaged, and the better the patient outcome,” says Ricciardi. “Minimizing ‘door to balloon time’ is critical in realizing our goal to provide the best heart attack care possible.”
The series of steps involved in this process (including ER triage, electrocardiogram, and the angioplasty itself) used to take more than 170 minutes. Today at UNM, the same process takes, on average, less than 90 minutes. “The 90 minute goal is something that every full service cath lab aspires to,” says Ricciardi, adding that UNM’s improvement has made them a role model for other cath labs around the country.
In fact, the UNM Cath Lab was recently invited by the University HealthSystem Consortium (UHC) to give a web conference presentation on how they achieved their success. UHC represents over 90% of the nation’s academic medical centers and works to improve clinical, operational and patient safety performance. According to Ricciardi, the key to their success was breaking down each step of the process, looking at ways to improve at each level, and establishing a patient-first team approach with the emergency department, diagnostic heart station, quality improvement department, and the cath lab staff.
In the midst of the progress in ‘door to balloon times’ has come a more than 100 percent increase in angioplasty volume at UNM in the past 12 months. Some of this increase is due to the Cath Lab’s outreach efforts. “In addition to local efforts, we are working with rural hospitals and UNM’s Lifeguard air transport service to get heart patients here seamlessly and as quickly as possible,” explains Ricciardi. “Whether coming from far or near, the data show that New Mexico cardiac patients are benefiting from the UNM’s commitment to cardiac care and ongoing collaborative efforts within and between departments.”