Cardiac cath lab improvements bring more patients

Charge Nurse Michael Cunico (from left), Senior Staff Nurse Lynn Cochran, Staff Nurse Myrna Sullivan, Cardiovascular Technician Jessica Ray, Lead Cardiovascular Technician Mary Fulmer, Senior Staff Nurse Peter Stoehr and Staff Nurse Andrew Maloney, in the Adult Cardiac Catheterization Laboratory, have reduced the time it takes to diagnose and treat cath lab patients.

The staff of the Adult Cardiac Catheterization Laboratory has a lot of heart. It might be too much, at times. With just three interventional cardiologists dividing more than 1,200 cardiac cases a year, there’s a lot of heart-pounding action. They also treat more than 200 patients per year for peripheral artery disease.

“All indications are that we growing rapidly,” said Michael Cunico, Charge Nurse for the Adult Cardiac Catheterization Laboratory.

The adult cardiac cath lab diagnoses and treats coronary artery disease. By strategically placing catheters in the heart’s blood vessels and chambers, the physician can inject contrast dye while taking X-ray films. With these contrast-enhanced fluoroscopic images, they are able diagnose coronary artery disease.

If treatment is needed, the cardiologist contacts the patient’s primary care physician to formulate a care plan. But very often the plan calls for the team to immediately treat the disease with balloon angioplasty and coronary stents.

Traffic to the cath lab is up 10 to 20 percent, Cunico said. “Much of the increase can be attributed to the quality of care we offer along with our ability and willingness to take on the very difficult and high-risk cases. We have a core team made up of highly skilled nurses, cardiovascular techs, cardiology fellows and interventional cardiologists. We’ve also improved that care by decreasing what we call ‘door-to-balloon time,’” Cunico said.
Door-to-balloon time is measured in minutes from the moment a patient having an acute heart attack enters the doors of the hospital complaining of chest pains to the time a blockage is diagnosed and a balloon is inflated to help clear the blockage. The target time is 90 minutes, as recommended by the American Heart Association and the American College of Cardiology.

“We have met that 100 percent of the time this calendar year,” Cunico said.

But the cath lab is working to shave 30 more minutes off that time by 2014. This year, the hospital has met that new 60-minute goal 66 percent of the time. But, even more encouraging is that the average door-to-balloon time is 45 minutes. According to a 2011 report in the journal Circulation, the national median time is 64 minutes.

“While other facilities measure their success in minutes, we choose to measure our success in heartbeats. A classic heart idiom is ‘time is muscle.’  Every second we shave from our door-to-balloon saves heart muscle,” Cunico said.

Cunico attributes the cath lab’s success to the experience of the medical staff. “Two of our physicians account for more than 1,100 cases a year. They see everything.  They may be the best trained and busiest interventional cardiologists in the CSRA. Because we’re a teaching hospital, we’re more cutting edge, more willing to take on the challenging cases, including chronically occluded arteries and unprotected left mains. These are the patients that in the past were either guaranteed to have open heart surgery or destined to live a life of chronic chest pain.”

In 2008, the Society for Chest Pain Centers designated Georgia Health Sciences Medical Center as the first nationally accredited chest pain center in the CSRA.

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