by Candi Helseth
The Saint Thomas Chest Pain Network, which serves patients in 68 counties in central Tennessee and southern Kentucky, is proving that small, rural hospitals can achieve great things when everyone works together. In January the Chest Pain Network received $24,000 as one of six finalists for the Monroe E. Trout Premier Cares Award, which spotlights innovative programs that help medically underserved communities.
Better than awards, though, is the fact that 15 rural network hospitals have achieved Chest Pain Center Accreditation through the nationally recognized American College of Cardiology Accreditation Services (formerly called Society of Chest Pain Centers).
Saint Thomas data demonstrates that patients are seeking help faster, seeing an ER physician earlier, and, when necessary, transferred more efficiently to a tertiary center. Moving patients in remote areas into and through a system quickly and efficiently is critical to saving more lives, according to network education.
Saint Thomas Chest Pain Network is part of the Saint Thomas Health Regional Network under the umbrella of Saint Thomas Health, a nonprofit, faith-based health care system in Tennessee.
The Chest Pain Network (CPN) provides training and resources to rural EMS services and hospitals to improve early recognition, diagnosis and treatment for patients exhibiting signs and symptoms of Acute Coronary Syndrome (ACS). The CPN formed in 2006, and expanded in 2008 to include stroke and heart failure protocols. To date, eight rural hospitals have met the stroke network requirements and three have established heart failure outreach clinics.
“A lot of what we’ve accomplished with the training is speed, which is monumental when time is of the utmost importance,” said Debbie Yorba, emergency director at Lincoln Medical Center in Fayetteville, Tenn.
“Now we know within the first 10 minutes if the patients’ symptoms are cardiac related and if so, we know what direction to go with that patient.”
Lincoln Medical, a county hospital with outreach to 33,000 residents, is accredited in chest pain and stroke categories. Given the hospital’s size and limited specialized staff, Yorba was skeptical that Lincoln Medical could achieve chest pain accreditation when it joined the network in 2007. Today Yorba is one of the network’s biggest advocates.
Patients who can be treated appropriately at Lincoln Medical appreciate being able to stay closer to home, she said. Patients having a heart attack at admission are transferred using CPN’s One-Call system, which Yorba said greatly expedites the transfer process. If extreme weather delays EMS arrival, staff can appropriately monitor and medicate the patient until a helicopter arrives.
Saint Thomas CPN members know that a large percentage of their patients are at-risk. Rural populations, particularly those in the South and Appalachian region, experience risk factors that contribute to increased rates of heart disease and cardiac-related deaths, according to Rural Healthy People 2010. In 2009, Tennessee was ranked 46th in the nation for heart disease and 42nd in the nation for stroke. Kentucky is ranked 41st in the nation for health disease and 37th for stroke.
“Quality outcomes require seamless coordination between multidisciplinary providers such as the dispatch, a local hospital, EMS and Air Medical Services in order to save heart muscle,” said Ranee Curtis, executive director of Saint Thomas Health Network Services. “Crucial to our success are activities that provide uniform training to health care providers, regardless of where they live and work in the region. Standardizing protocols across urban tertiary facilities and small rural hospitals creates opportunity for a higher quality of patient care, and equally importantly, creates a culture of trust and respect between providers.”
According to Curtis, unnecessary patient transfers have dramatically declined as rural facilities’ comfort levels improve and education has provided greater understanding of which patients can be appropriately cared for in the rural environment. Door-to-Balloon Time has decreased by 48 percent at the Saint Thomas Hospital tertiary center; the other two tertiary centers have also noted decreases.
“Successfully treating heart disease and stroke symptoms begins by increasing public awareness,” Curtis added. “Community education has centered on risk factors and symptoms—as well as the importance of calling 9-1-1. Mock community drills have put all segments of the care plan into practice, from the initial 9-1-1 call to patient transfers to a tertiary care facility.”
Yorba said public drills helped the community better understand the importance of recognizing symptoms and seeking treatment earlier. Quarterly drills have enhanced speedy responses as hospital departments and the EMS work together to streamline care.
“There is no doubt that being in the Saint Thomas Chest Pain Network has made a difference for us and our patients,” Yorba said. “Our physicians and staff got on-site training and education so we are using the same protocols that patients would get at a Saint Thomas Health facility. We’ve also benefited from the involvement of these other rural facilities because we talk to each other, learn from each other and check results against each other.”
CPN has served more than 15,000 patients from nearly 1,000 zip codes. A data registry developed specifically for the network includes over 200 metrics for program evaluation and quality improvement.
Five Health Resources and Services Administration (HRSA) grants of approximately $2.1 million, along with organizational funding, have assisted network expenses. Grants include two Rural Network Development awards, a Rural Outreach award, a Rural Access to Emergency Devices award and a Rural Health Workforce Development award.
To learn more, contact Program Development Coordinator Audrey Daniel at Audrey.Daniel@stthomas.org.
Back to: Winter 2012 Issue