Methodist Richardson Medical Center (MRMC) and the Richardson Fire Department (RFD) were recognized by the American Heart Association for having the fastest total combined patient treatment time for cardiac events for the first quarter of 2011 for the state of Texas.
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Learn how Methodist Richardson Achieved Fastest Total Patient Treatment Time for Cardiac Events
1. Collaboration Between the ED and the Local
Fire Department Improves Results, Saves Lives
An EmCare® Case Study
Methodist Richardson Medical Center
Richardson, Texas
4. 2
Introduction
Methodist Richardson Medical Center (MRMC), a non-profit hospital
in Richardson, Texas, has offered compassionate medical, surgical and
behavioral health services for more than 40 years. MRMC has received
numerous recognitions and accreditations, including:
• Sleep Disorders Center accredited by American Academy of Sleep
Medicine
• Cancer Center accredited by American College of Surgeons
Commission on Cancer
• Advanced Primary Stroke Center designation by American Stroke
Association
And, recently, the EmCare-affiliated emergency department at MRMC
in Richardson, Texas became one of only a few in the Dallas area to be
named a Cycle III Chest Pain Center and Heart Failure Center- the highest
level of accreditation by the Society of Chest Pain Centers.
Challenge
Every day in Dallas County, approximately 30 people suffer a heart attack
and depend on the seamless delivery of emergency medical services to
increase their chances of survival and quality of life. Cardiovascular disease
is the number one killer of all Americans and current survival rates in
Dallas County are lower than the national average. Response times vary
across hospital systems and EMS providers, and that critical time can mean
the differences between life, death and permanent disability.
“It is the time of reduced blood flow to the heart that counts, not just
the time the patient arrives at the hospital,”says Dr. Nhan Nguyen,
interventional cardiologist and medical director of Cardiology at MRMC.
The hospital had two goals: to improve results for those who suffered
heart attacks in the region and to earn accreditation as a Chest Pain Center
and Heart Failure Center. To achieve this status, hospitals must meet or
exceed a comprehensive set of stringent heart failure care criteria and
undergo an on-site evaluation by members of the Society of Chest Pain
Centers review team.
Solution
To ensure the medical center met the survey criteria, Dr. Elizabeth Fagan,
EmCare Regional Medical Director, and Medical Director Dr. Brian Kenjarski
Every day in Dallas
County, approximately
30 people suffer a heart
attack and depend on
the seamless delivery
of emergency medical
services to increase their
chances of survival and
quality of life.
5. 3
The hospital works closely
with Richardson Fire
Department to improve
emergency services to the
surrounding community.
partnered with all of the hospital departments involved in the care of
heart failure patients and standardized order sets to ensure appropriate
treatment and documentation. The medical center also developed risk
stratification tools to ensure patients are appropriately placed in either an
observation bed or inpatient bed.
“The survey is very intense as the survey team evaluates every facet of
your program,”said Dr. Fagan, who has also served as the emergency
department medical director at MRMC. The survey included a review
of the medical center’s involvement in EMS education, ED evaluation
and treatment, inpatient care, discharge planning, patient education,
community outreach, process improvement and other areas.
Through a multi-million dollar grant initiative between the American
Heart Association (AHA) and W.W. Caruth, Jr. Foundation, efforts are being
made to streamline protocols between participating hospitals and EMS
agencies in a collaborative effort to reduce response times, increase action
and coordinate data transfer. Every second counts and critical seconds are
gained when effective coordination occurs.
As part of the efforts to prepare for the survey and to improve emergency
services to the surrounding community, the hospital worked closely
with the Richardson Fire Department. Dr. Fagan stated that, in this case,
working with local EMS providers was crucial to meeting evaluation
criteria.“Partnering with EMS allowed us to educate all providers who take
part in the care of our community’s heart failure patients, from 9-1-1 call
to discharge,”she said.
Results
In February 2011, the EmCare-affiliated emergency department at
Methodist Richardson Medical Center received Heart Failure Accreditation
from the Society of Chest Pain Centers. It is the twenty-sixth facility in the
United States and the first in Dallas to receive the certification.
On Wednesday, August 24th Methodist Richardson Medical Center and
the Richardson Fire Department were recognized for having the fastest
total combined patient treatment time for data submitted to the AHA
Dallas Caruth Initiative during 1st Quarter, 2011.
Specific initiatives of the program include convening EMS and hospital
emergency providers to regionally standardize emergency heart attack
treatment and transport protocols, report and share patient care and
quality improvement data, increase professional education standards and
6. 4
eliminate equipment gaps so all EMS providers can identify suspected
heart attack patients in the field and transmit to the hospital for expedited
transport and treatment.
Dr. Fagan believes the certification should provide benefits to both
the medical center and the patients for whom care is provided.“Early
identification, prompt treatment and aggressive patient education will
improve the care we can provide to our patients and decrease their
readmission rate,”she said.
The process is relatively simple:
• The patient is picked up by an ambulance to be taken to the hospital
• Richardson EMS personnel evaluate the patient and if STEMI presents,
they field-activate the cath lab
• Upon arrival at the hospital, the patient is taken through the ER where
emergency medicine physicians can treat the patient on the way to the
cath lab if needed
• In the cath lab, cardiologist and hospital team perform a heart
catheterization and place a stent in the patient’s blocked artery
• Once the patient has been catheterized, he or she is moved to a
hospital room until discharge
“Patients who recognize heart attack symptoms and quickly call 911 can
be treated through a coordinated effort between EMS and healthcare
providers,”states Dr. Elizabeth Fagan. She continues,“The national goal is
a response time of less than 90 minutes from the time the patient arrives
at the hospital (door) to the time the blocked artery is open (balloon).
Methodist Richardson Medical Center has met that goal 100 percent of the
time for nearly three years. For the previous six quarters‘door to balloon’
time average was only 59 minutes.”
EmCare focuses on helping each hospital partner with efficiency,
quality and patient satisfaction. In short, EmCare is making health
care work better.™
A Case Sample
A 66 year old male experienced and recognized the symptoms associated
with a cardiac event and, through a series of controlled coordination
between the patient, the EMS and hospital staff, symptom onset through
arterial reperfusion (SOAR) was reduced to 43 minutes. This is a significant
reduction in response time when compared to the median reported
EmCare focuses on helping
each hospital partner with
efficiency, quality and
patient satisfaction.
7. 5
response times in Texas of 171 minutes, or just under three hours. The
timeline of events is listed below (some times are approximates):
12:20 pm: A 66 year old male experienced chest pain doing yard
12:28 pm: Patient dials 911
12:33 pm: Richardson Fire Department EMS arrives on scene
12:40 pm: ECG completed and cardiac cath lab was activated
from field
12:45 pm: Patient arrives at ER; cardiologist conducted another
12-Lead ECG at the door
12:57 pm: Patient arrives in cardiac cath lab
1:03 pm: Artery opened, blood flow restored to heart
About EmCare®
EmCare is the leader in physician servicesTM
serving more than 500 hospitals
nationwide. Founded nearly 40 years ago, today the company handles
more than nine million patient encounters annually. The integrated
company consists of four service lines including emergency medicine,
hospital medicine, anesthesiology and radiology/teleradiology. The
company is focused on:
• Leadership
• Delivering high quality clinical care
• Improving performance metrics
• Achieving superior patient and staff satisfaction
• Managing costs
For more information on how EmCare can help your hospital strengthen
its emergency medicine practice, feel free to visit us online at
www.EmCare.com. Following the link“Solutions for Hospitals”will offer
more information on the services EmCare’s other specialty divisions–
Hospital Medicine, Anesthesiology and Radiology / Teleradiology – can
provide.You may also contact a business development representative
directly at (877) 416-8079.