In emergency treatment of heart attacks, “door-to-device time” refers to the interval from when the patient is present in the emergency department to when their artery is opened in the cardiac catheterization lab.
The National Cardiovascular Data Registry shows the median door-to-device time for U.S. hospitals to be about an hour. The 90th percentile is about 45 minutes.
In 2018, Iredell Memorial Hospital’s door-to-device time was less than 30 minutes.
“When the best providers in the country are doing it in 45 minutes and you’re doing it in less than 30, you’re doing something pretty well,” said Charles Deberardinis, DO, FACC.
Deberardinis is an interventional cardiologist and is also the medical director for the Iredell Heart & Vascular Center. Jips Zachariah, MD, FACC, of Piedmont Healthcare Cardiology, is the other interventional cardiologist at Iredell helping to make sure patients receive the critical care they need.
The first step to achieving efficient door-to-device time is for emergency medical services (EMS) to recognize that a person is having an acute heart attack. Iredell County possesses the necessary technology to enable a paramedic or emergency medical technician (EMT) to perform an electrocardiography (EKG) on-site before transmitting the results to the hospital emergency room. The EKG helps diagnose heart attacks by recording electrical signals in the heart to determine heart rate, heart rhythm, and other information indicating the heart's condition.
Once the hospital receives the assessment from EMS, the emergency room physician and cardiologist confirm whether the patient is suffering a heart attack and if the artery needs to be opened immediately.
Prepared hospital employees then aim for patients to hardly touch the ground in the emergency department. A doctor or nurse practitioner performs a swift assessment to ensure the patient is stable enough to get to the catheterization lab before being moved there. Once there, an interventional cardiologist inserts a catheter, uses an x-ray to create images to see the blockage, and then opens the artery.
“I characterize it as a dance,” said Skip Meador, Iredell Health System’s director of cardiovascular services. “There is extraordinary collaboration between EMS, the emergency department, and the cardiac catheterization lab, and emergency room personnel are communicating with EMS from the get-go. Then once the patient arrives, we get them treatment and make sure they’re stable with very fast times and great outcomes.”
Iredell Emergency Department providers and directors emphasize creativity in collaborating with EMS teams. And initial EKGs are completed in the field, enabling patients to go directly to the catheterization lab, bypassing the emergency department and saving critical time.
“A real success is us getting the EKGs done on the patients very quickly,” said Brian Beaver, MD, medical director of Iredell Memorial Hospital’s Emergency Department and medical director for Iredell County EMS. “We are aware and prepared even before the patient is here. They can be 20 minutes away somewhere in Iredell County and come right on in.”
Iredell Memorial remains loyal to the motto “time is muscle,” emphasizing that door-to-device time correlates with the amount of damage to the heart muscle. Shorter door-to-device times typically result in better patient outcomes.
“There has been a lot of scrutiny across the country in improving the timeliness of heart attack care, and providers have done a lot of work to streamline that process,” Zachariah said. “If you truly believe that time is muscle, and it is, then for the person in an acute phase of a heart attack, getting care quickly is critical. We have heart-saving and lifesaving capability and we’re doing it truly world-class.”
Pictured: Dr. Charles Deberardinis and Cath Lab Manager Larry Morrisette.