In 2005, Pioneer Memorial Hospital joined the 100,000 Lives Campaign, a voluntary patient safety initiative begun by the Institute for Healthcare Improvement. This initiative became the 5 Million Lives campaign in 2006. 

As part of this initiative, our caregiving team in the Emergency Department is focusing on improving care for patients who come in with symptoms of acute myocardial infarction or chest pain. “These patients have a condition we call STEMI,” says Virginia Sandau, a registered nurse and PMH risk management supervisor who has been closely involved in our improvement process. STEMI refers to a specific segment of the line in the echocardiogram, or EKG, reading that is higher than normal. “PMH baseline data was gathered from September through December 2007. During that time, PMH had four STEMI cases,” Sandau said. 

PMH, along with seven other Critical Access Hospitals in Oregon , has received a flex grant administered by the Oregon Office of Rural Health in Portland for this study. The grant period will end in July of this year. 

The grant uses the quality improvement model called “rapid cycle.” This is where small changes are made and analyzed to see what works. If a change works, it is implemented. The team then moves on to the next small change. “This process helps us adapt new things quickly, looking intensely at one thing at a time, rather than changing everything all at once,” says Sandau.

Our AMI team is working with cardiologists Dr. Hugh Adair, III and Dr. Michael Widmer, who practice with The Cardiology Group of Bend . They have met on-site with physicians and caregivers.

“We in Central Oregon are already ahead of the curve with regard to pre-hospital care for STEMI patients,” Sandau said. “The paramedics aboard ambulances in Crook County work aboard vehicles that are equipped with 12-lead EKG’s and the wireless network technology needed to transmit the data to the hospital before they arrive.”  When the EKG is received, the Emergency Department physician can look at the reading to confirm what data is being revealed, and to determine and advise the ambulance team on the correct protocol for treatment before they even reach the hospital with the patient.   In some cases, the recommendation may be to set up a rendezvous with Air Life of Oregon directly, and to skip coming in to the hospital.

Once the STEMI is confirmed, a patient receives either fibroinolytics to open the blood vessels, or percutaneous coronary intervention, more commonly known as coronary angioplasty.

Newly-adopted guidelines call for treatment within 90 minutes.

“All area hospitals are challenged to meet this guideline, to get the patient from the field to the catheterization lab in Bend with a wire in place to deliver fibrinolytics.” Sandau said.   “So we are looking at our process pre-hospital, in the hospital, during transportation and in the catheterization lab. 

   “For treatment of a suspected heart attack, our system works best when an ambulance is called,” she said, “because we in the ED get a heads-up to prepare. Even if you think you will save time by driving your friend or family member to the hospital, when you call 911, the paramedics will arrive very quickly.    They are trained and equipped to begin treatment at once.”

Some heart attacks are sudden and intense, but most heart attacks start slowly with mild pain or discomfort. Often people affected aren’t sure what’s wrong and wait too long before getting help.

Here are signs that can mean a heart attack is happening:

*  Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.

*  Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.

*   Shortness of breath with or without chest discomfort.

*   Other signs may include breaking out in a cold sweat, nausea or lightheadedness.

As with men, women’s most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea or vomiting and back or jaw pain.

This list of symptoms can be found on the American Heart Association’s Web site: www.aha.org/heart attack symptoms.

“It’s all about our patients receiving the best care,” Sandau said. “We always look for ways to improve. At the end of this project, we will establish a treatment model to be used by rural hospitals in Oregon , and possibly nationwide as well.”

*The information in this article was originally published in The Central Oregonian on April 1, 2008, as the Health Matters column.