Monday, March 28, 2011
The agency that coordinates emergency medical services throughout Maryland has designated the University of Maryland Medical Center (UMMC) as a Cardiac Interventional Center. The three-year designation is part of a new regional network of skilled cardiac facilities that provide time-sensitive, high-quality treatment of the most severe type of heart attack, caused by the complete blockage of a coronary artery. The designation means that, as of April 1, 2011, ambulances transporting patients suffering from this type of life-threatening, in-progress heart attack will take patients for optimal care directly to centers such as UMMC, bypassing hospitals that lack this certification.
To meet the rigid standards set by the Maryland Institute for Emergency Medical Systems Services (MIEMSS), a hospital must provide skilled cardiac care 24 hours a day, seven days a week, including a variety of catheter-based techniques, such as balloon angioplasty, to relieve narrowed or blocked heart arteries. In addition, a Cardiac Interventional Center must have systems in place to ensure that a balloon catheter is inflated in a blocked artery within 90 minutes or less for 75 percent of appropriate patients. The University of Maryland Medical Center exceeds those standards.
“Timing is muscle when it comes to treating people with major heart attacks,” says Mandeep R. Mehra, M.B.B.S., professor of medicine, head of the Division of Cardiology at the University of Maryland School of Medicine and chief of cardiology at the University of Maryland Medical Center. Research has shown that if blocked arteries are opened and blood flow is restored within 90 minutes of a patient’s arrival at the hospital, the chance of survival rises significantly, while the loss of heart muscle function decreases.
This so-called “door-to-balloon time” is particularly important in a type of heart attack that doctors call STEMI, or ST elevation myocardial infarction. “We have developed procedures and quality control measures that rapidly focus expertise from throughout the Medical Center to get STEMI patients the help they need,” says Dr. Mehra. “We have also bolstered our partnerships with city and county ambulance units and University of Maryland ExpressCare.” ExpressCare is a transport service that enables community physicians in Maryland to transfer critically ill patients to UMMC for specialized care.
“The designation of UMMC as a Cardiac Interventional Center caps the efforts of scores of faculty members, nurses and technicians who work together every day to raise the quality of patient care,” says Jeffrey A. Rivest, president and chief executive officer of the University of Maryland Medical Center.
MIEMSS sent a team of inspectors to the Medical Center to review policies and procedures and examine the emergency department, the catheterization laboratory, the pharmacy and the cardiac care unit. To maintain a high level of readiness, key personnel within the Medical Center meet regularly to review every case and explore ways to become even more efficient, especially after hours.
“The methodology employed to develop, test and refine this process is similar to that employed throughout the Medical Center and the School of Medicine to practice and improve upon evidenced-based medicine, solidly grounded in research,” says E. Albert Reece, M.D., Ph.D., M.B.A., vice president for medical affairs at the University of Maryland and dean of the University of Maryland School of Medicine.
The goal of this new system, according to MIEMSS, is to transport the right heart attack patient to the right center in the right time. The new system will be similar to the state’s world-renowned trauma care system for victims of shootings, serious car crashes and other major injuries, which originated at the University of Maryland R Adams Cowley Shock Trauma Center.
Under the system currently in place, STEMI patients are transported to the nearest hospital regardless of its ability to treat these people. Doctors at the first hospital may conclude that the patient needs advanced treatment at another facility, triggering additional transport at the expense of critical, life-saving minutes.