Brandywine Reports Extraordinary First Quarter Results for Door-to Balloon Time

Every minute counts during a heart attack. The faster blood flow is restored, the better chance a patient has for a full and rapid recovery. Performance standards, such as those set by the Centers for Medicare and Medicaid Services (CMS) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), call for at least 75 percent of patients experiencing a major heart attack to receive life-saving treatment in 90 minutes or less upon arrival to the hospital. Brandywine Hospital decided it could do better than that, and it did.

“Based on first quarter CMS/JCAHO core measure data, Brandywine Hospital has exceeded the ‘gold standard’ in heart attack care,” said Annette DiEugenio, RN, Director of Cardiovascular Services, Brandywine Hospital.

Brandywine’s average door-to-balloon (D2B) time--the time it takes to treat a heart attack patient from the moment when he or she arrives in the emergency room (ER) to the moment their blocked artery is open --is 72 minutes for all patients with a common type of heart attack called STEMI for ST-elevated myocardial infarction. That is 18 minutes (20%) below the benchmark. 

“These results reflect the focus that Brandywine Hospital has placed on continuous improvement, especially in the area of heart attack care,” declared Mark A. Benz, Chief Executive Officer, Brandywine Hospital. “Congratulations to our physicians and staff, who have worked tirelessly to improve the process of care and reduce the time to treatment, making Brandywine the hospital of choice in our community for heart attack care.”

As interventional cardiologist, Antonio J. Chamoun, M.D., explains, an exceptional partnership between the ED and interventional cardiology is an essential factor in this success. Once the triage nurses make the initial assessment and initiate the heart attack protocol, a well-orchestrated ED and cardiac team must efficiently manage patients to assure their hearts have blood flow restored as quickly as possible.  

“Percutaneous coronary intervention (PCI), commonly known as angioplasty, consists of a variety of procedures preferably used to open blocked arteries and restore blood and oxygen to the heart,” added Dr. Chamoun. “Typically this is done by inserting a thin, balloon-tipped tube or catheter into the artery, inflating the balloon, and placing a metal stent inside to keep the artery open.”

Another factor important to Brandywine’s success is the focus of a multi-disciplinary treatment team who continuously examine their standard of care and identify areas for improvement. As a result, certain strategies were implemented to help limit DTB time, including: obtaining an immediate EKG, a key diagnostic tool, on patients with chest pain; the physical presence of an ED physician to read the EKG results; a one-page system to activate the cardiac catheterization laboratory so the team is ready in under 30 minutes; and continuing education opportunities for ED staff members.

"Our intent wasn’t to change clinical practice, but to change how we coordinate the delivery of care to positively impact patient outcomes," said DiEugenio. "Each step in the treatment process for STEMI patients was examined for inefficiencies, duplication, and non-standardization because it’s not only the speed, it’s also the level of care patients receive at Brandywine that really makes the difference.”

In 2000, CMS established its core measures and began publicly reporting the data in 2003. These measures were developed from evidence-based medicine, meaning each has scientific proof it will provide effective outcomes. Since 2003, Brandywine Hospital has participated by tracking and recording data on its treatment for heart attacks