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For cardiac care nurses in ICUs or EDs, the faster-paced decision process provides several advantages, according to a CDU supervisor at Medical City.

“It makes us feel like we’re getting things done,” says Gail Allen, RN, CCRN. “Doctors pay more attention to us here in the ER area, and we do things much faster and more efficiently, I think.”

By delineating the patient load among heart attack victims, likely candidates, and those fully cleared, Allen says she’s able to devote more time to her patients. “We can actually give them the attention they need vs. on the floor with 60 beds,” she says. “With my 10 beds, even though there’s only two of us here, if they need to have a heparin drip or something going, I can usually get to it right away.”

When Medical City and sister HCA Dallas/Fort Worth–area hospitals Medical Center of Plano and North Hills Hospital of North Richland Hills were granted accreditation last October, all three were the first in North Texas to be designated. Only 92 hospital chest pain centers nationwide have been designated, including 11 in Texas.

SCPC accreditation is a comprehensive process that measures eight elements required of a hospital’s operations:

• ED integration with EMS systems
• Emergency assessment, diagnosis, and treatment of acute coronary syndrome (ACS) patients
• Assessment of patients found with low to moderate risk for ACS
• Functional facility design
• Personnel, competencies, and training
• Organizational structure
• Process improvement orientation
• Community outreach program

Baxter says the chest pain center accreditation process can be arduous. He points to a phone-book-size binder in his office, containing Medical City’s documentation of its protocols meeting SCPC standards.

“If someplace doesn’t have bedside testing, doesn’t have clinical pathways that are set up for treatment recommendations 85 if they’re not looking at ways to improve their door-to-inflation time, if they’re not looking at a door-to-EKG time of less than 10 minutes 85 they have a lot of work to do,” says Baxter. “A lot of those things were already in place 85 here at Medical City Dallas. Some of those weren’t as big of a hurdle for us.”

Gaining the accreditation does not stop the quest for improved care. Kadlec Medical Center of Richland, Wash., is among several accredited hospitals looking to streamline the process of wirelessly transmitting paramedics’ 12-lead ECG field tests into the hospital before a patient’s arrival.

“We had a case in August or September where a guy at a hotel 85 woke up at 2 AM with a heart attack,” says Kadlec’s Roger Casey, RN, BSN, CEM. “The paramedics responded, ran [and transmitted] the 12-lead EKG in the field, and we had the cath team here by the time he got to the door.”

Only a small percentage of patients have actual cardiac episodes when admitted to the ED — as little as 10% to 15%, according to the SCPC. From 4% to 13% are mistakenly discharged, with 11% to 25% of those dying from heart attack.

Cardiac diagnoses have a major impact on the bottom line. Mistaken diagnoses are the most costly subject of malpractice litigation against emergency physicians. On the other hand, patients admitted for false symptoms cost both the patient and the hospital in excessive medical fees.

Generally, though, according to the SCPC and advocates for chest pain centers, the losses they most want to prevent are the lives of patients themselves.

Glen Fest is a managing editor for NurseWeek.

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