Story Photos
 St. John Medical Center's relationship with Oregon Health & Science University may have saved the life of Cam Hanna, 52. Bill Wagner / The Daily News
|
A Heartbeat Away
Sunday, March 30, 2008 6:13 AM PDT
By Barbara LaBoe
blaboe@tdn.com
Printable version
E-mail this articleWhen Cam Hanna went to St. John Medical Center with chest pains earlier this month, the Castle Rock resident had no idea he'd soon be in a helicopter bound for a Portland operating room. He also didn't know the trip was part of a new partnership with Oregon Health & Science University that officials say will improve all aspects of cardiac care in Longview.
But Hanna, 52, said he was amazed at how quickly the transfer took place.
"I was at the hospital (in Longview) at 10 a.m., and I was in the operating room down there by 11:15," he said Wednesday. "They took me off the helicopter with the blades still going, and the next thing I knew I was on the surgery table. ... It was like poetry in motion."
That's exactly what officials at both hospitals want to hear about their new working relationship.
Short-term, the partnership has sped up how acute heart attack patients like Hanna are treated and transferred to Portland. Long-term, it should mean more cardiologists and services available in Longview and more chances to collaborate with experts at OHSU.
"It really is a tremendous opportunity to continue to augment the wonderful cardiovascular service that's already been developed at St. John," said Dr. Joaquin Cigarroa, associate chief of cardiology and director of the cardiac catheterization laboratories at OHSU. "And the most important part is that the patients stand to benefit the most from this."
The most immediate impact, though, is apparent in heart attack patient transfers.
When acute heart attack patients come to the emergency department there are two treatment options: inserting a stent in a catheterization lab to open up a blocked artery, or administering clot-busting medicine, Cigarroa said.
The stent, a small mesh tube that props open an artery, is the preferred method of treatment - but only if it can be inserted within 90 minutes. Stents are sometimes inserted after longer periods, but if doctors know there's going to be a delay, clot-busting medication is the better bet. But for best results, the medicine should be given within 30 minutes of a patient's arrival - well before the stent timeline runs out.
So watching the clock is crucial, Cigarroa said.
St. John's cath lab is not licensed to insert stents, meaning that in the past - with the clock ticking - doctors had to call regional hospitals to see if they had room to take a Longview patient. The discussion also included insurance information and other details that tended to delay the critical decision.
"Before you know it, 30 to 40 minutes have passed and now the transfer has to be arranged" because the window for drug intervention has passed, Cigarroa said. "And the average time once transfer was arranged was 180 minutes, so many patients had their treatment delayed."
With the partnership, all acute heart attack patients at St. John now go to OHSU automatically and there's no wondering if they'll be accepted. Life Flight also has agreed to launch for all needed transfers, even if it means turning back if the situation changes, said Cal Lantz, St. John's vice president of professional services.
"Now, a simple call is made," which launches the entire new protocol, Cigarroa said.
The change allows St. John to get someone from its emergency department into an operating suite at OHSU within 90 minutes of arrival at St. John.
Patient transfers started in late fall, but the full-fledged program debuted earlier this month with an 88-minute transfer. Several dozen patients have been transferred since the initial trial phase began.
It wasn't an easy task, though.
St. John, OHSU and Life Flight officials all had to work together to ensure the transfer times would work, as did many members of their staffs, Lantz said. The flight itself takes about 20 minutes, but patients must be prepped and ready for transport before they're ever loaded into a helicopter. And even relatively simple things, like the type of IVs and tubing used, had to be standardized between St. John, OHSU and Life Flight to eliminate costly time spent switching between systems.
"We've been able to shave off 15 minutes of transfer time with that (coordination)," Cigarroa said. "And this isn't something that just happens by accident."
"It's like a baton race where you're passing that thing off to the next person, and everything was really smooth," Hanna said of his own transfer. He was released from OHSU two days later and already is back at work as a construction project manager in Portland.
The partnership came about because St. John has been trying for some time to increase its number of cardiologists. Currently there are two, but there's a need for four. That means waits for elective procedures can be months, though emergency cases are always seen right away, said St. John's Dr. Noel Santo-Domingo.
Cardiologists are a hot commodity nationwide, so attracting the
doctors to Longview has been a struggle. The hospital even sent out 10,000 postcards to cardiologists across the country a year ago, hoping to drum up new candidates.
One of those postcards caught Cigarroa's attention, and he and his OHSU bosses decided to partner with St. John.
"One of our strong commitments as an academic medical center, and as a personal commitment for me, is to look around the various communities to see if there is a need and a desire to enhance services on site," Cigarroa said. "Being part of the community is important."
What's resulted is the heart attack transfer partnership, as well as a plan for OHSU to hire two doctors who will live in Longview and practice at St. John four days a week. The doctors, who will start as soon as they can be recruited, will spend the remaining weekday at OHSU working on research or other projects.
"It's important the doctors live in the Longview area, but the ability to spend a day a week at the university, I think, will allow us to attract more individuals," Cigarroa said. "It sort of rounds out the experience for the person."
Cigarroa and other OHSU doctors also are making clinic rounds in Longview and conducting training for staff here. And, through telemedicine and electronically transferred records and scans, St. John doctors can consult with OHSU specialists in real time instead of sending a patient south for a second exam.
The partnership is not costing St. John any additional money, Lantz said. Hospital spokesman Randy Querin said the cost for patients also is the same regardless of whether it's a St. John or OHSU doctor treating them. Patients will be billed by St. John for all treatment, and then the hospital will in turn bill OHSU.
The staffing of OHSU doctors in Longview also means that patients won't have to travel to Portland as often for follow-up visits. And it should allow St. John to add more specialty clinics such as one geared specifically for heart failure patients.
And, pending state approval, the hospital hopes to expand its catheterization lab services as part of a $7 million remodel and expansion of its lab and radiology department this fall, said Lantz. This PeaceHealth expansion is separate from the ongoing $46 million hospital tower renovation.
The hospital's existing lab allows doctors to perform some procedures, such as placing pacemakers, but they need additional capacity and state approval to start doing surgical angioplasties and inserting stents. Eventually, officials would like to save patients the time and expense of a flight to Portland. Officials also would like to be able to do non-emergency stent work to further keep care and patients local, Lantz said.
"We're not going to stop here," said Santo-Domingo. "We'll continue to expand our services."
"This is step one, but it's really just the beginning," added Cigarroa.
As far as Hanna is concerned, though, the first part of the partnership is a complete success.
"In the past you maybe heard something negative about St. John, and you never know what to expect when you head to the emergency room like that," he said. "But we were so impressed. They really brought their A game."
Debbie Burchett wrote on Mar 30, 2008 8:41 AM:
They would not release my mother until they were completely convinced that not only was she no longer in danger but also was mobile again.
My mother is now home and recuperating and it would not have been possible without both the intervention of St. John's and OSHU.
I had heard bad press about St. John's but I could not have located a better facility if I had tried. "
OK ? wrote on Mar 30, 2008 8:42 AM:
Citizen wrote on Mar 30, 2008 9:11 AM:
I am glad to see the hospital make the effort to save more people by getting them to OHSU ASAP. Our local hospital simply does not have the staff to do what OHSU does to save lives of heart patients.
Now it is up to the community to make sure they are INSURED so that this service is paid for and we don't have to have the car washes and collections every time someone is medivac'd to OHSU. Please get insured! ! ! ! "
Hey, Cam! wrote on Mar 30, 2008 9:22 AM:
French wrote on Mar 30, 2008 10:22 AM:
To Citizen... wrote on Mar 30, 2008 10:30 AM:
castle rock res. wrote on Mar 30, 2008 11:38 AM:
life is all about choices wrote on Mar 30, 2008 11:41 AM:
sucks wrote on Mar 30, 2008 11:42 AM:
to Citizen wrote on Mar 30, 2008 12:53 PM:
To Citizen wrote on Mar 30, 2008 1:02 PM:
RE. Citizen wrote on Mar 30, 2008 1:12 PM:
EMS WORKER wrote on Mar 30, 2008 1:53 PM:
bored reader wrote on Mar 30, 2008 1:55 PM:
To Citizen wrote on Mar 30, 2008 1:55 PM:
To all you rich people, wrote on Mar 30, 2008 2:04 PM:
To Citizen wrote on Mar 30, 2008 2:11 PM:
Beenthere wrote on Mar 30, 2008 2:20 PM:
I am not making this stuff up.
I was there , had to have bypass surgery. they are very good at what they do.
Was at St.Johns too, got about average care there.
Fix your #1 tdn "
To: life is about choices wrote on Mar 30, 2008 2:28 PM:
To Citizen wrote on Mar 30, 2008 2:34 PM:
Life is sometimes what is given you not what you choose. I make hard choices every day for my children that I chose to have with my husband some years ago when we did have insurance and I was a stay at home mom. He is no longer here with me and I do everything in my power to take care of my children with my two years of college. You have come to the conclusion that I am a single mom who is single because I had unprotected sex and got my self that way because of being irresponsible. On the contrary, I chose to have my children and to marry my husband who worked at Fiber. We HAD a good life and insurance. I NO LONGER do have insurance and I CHOOSE EVERY DAY to do what is right for my kids. You are a very judgmental person who has made too many assumptions. "
been there, still there wrote on Mar 30, 2008 2:56 PM:
What were we talking about again? wrote on Mar 30, 2008 4:14 PM:
Californian wrote on Mar 30, 2008 4:18 PM:
I could have had heart surgery locally, but the other hospital has a better
reputation for cardiac care - the local
hospital even acknowledges that. There
is nothing wrong with getting the best care, and nothing wrong with local hospitals acknowledging where the best care can be obtained. Cooperative care
saves lives and provides the best care.
I am very happy for Mr. Hanna and his family, and happy to see cooperative health care worked well for him.
"
local who knows wrote on Mar 30, 2008 7:21 PM:
Re: To life is about choices wrote on Mar 30, 2008 8:04 PM:
These are the lamest excuses ever.... "
me wrote on Mar 30, 2008 11:51 PM:
tired wrote on Mar 31, 2008 5:23 AM:
Stop whining and feeling sorry for yourself. "
to: local who knows wrote on Mar 31, 2008 8:37 AM:
If someone comes in to the emergency department having a specific type of heart attack (they aren't all the same and each requires different treatment), and the doctor feels he/she needs to be transported to Portland, that person has the right to refuse what the doctor feels is best. If the patient does not want to go to OHSU, they do not have to. But, in a situation where every minute not treated causes more heart muscle damage, I know that I would not choose waiting several hours for another facility to accept me as a patient.
The partnership between OHSU and St. John's isn't perfect, but it's a huge step in the right direction and getting better all the time.
Thanks for the great article TDN. Only thing wrong is that this program does not apply to Kaiser patients (Kaiser's rules, not St. Johns). "
Adding to “local who knows” wrote on Mar 31, 2008 9:18 AM:
Nice comments. Accurate and to the point. I want to add some additional thoughts. St John is a large community hospital. It can’t and shouldn’t provide all services under one roof. Most hospitals in Portland are larger and can provide a higher level of specialty care in many areas.
Community hospitals transfer a lot of patients to larger hospitals. There are lots of reasons for doing so, but high quality patient care is centered on “what is best for the patient”.
That means, when you need a neurosurgeon or a cardiothoracic surgeon, you should be transferred to a facility where those physicians and nurses are well practiced. Vancouver and Portland have those facilities; however, hospital beds are often times scarce which can delay prompt care.
The new agreement between OHSU and St John for heart attack patients provides the best care for the patient. Read the article carefully. OHSU’s door is always open, no lines, no waiting: “all acute heart attack patients at St. John now go to OHSU automatically and there's no wondering if they'll be accepted”.
This should be celebrated. Nice article TDN!
"
to: local who knows wrote on Mar 31, 2008 9:23 AM:
Life Flight wrote on Mar 31, 2008 5:07 PM:
It's more like $15K wrote on Mar 31, 2008 5:11 PM:
Way to go SJMC wrote on Mar 31, 2008 7:21 PM:
To Bored Reader wrote on Mar 31, 2008 9:03 PM:
Going down wrote on Apr 1, 2008 12:08 AM:
find a new job!! wrote on Apr 1, 2008 12:29 PM:
Past Month's Most Commented Stories