Cardiac team recognized for patient care

Aug. 21--Print Article

The Summit Fitness Center on a Friday morning hums with activity -- fit joggers pound on treadmills, weight machines clang and a rehab specialist greets "Good Old Lex" Blood, a 40-year resident of Kalispell, with a wave and a hug.

"Old is the operative word," Blood laughed.

With a heart monitor snaking down his chest, Blood takes a turn on a rowing machine. He's one of 250 patients treated last year with stents by the physicians and staff at Rocky Mountain Heart and Lung at Kalispell Regional Medical Center. But that number is more of a testament to cooperation than a procedure; cardiac medicine requires a high level of coordination to guide patients through a complex system of care -- emergency response, testing and diagnosis, imaging, surgery, post-operation care and rehab -- that can last weeks. When Blood presented with a heart attack in the middle of the night this May, it's this system that allowed him to be on the rowing machine in August. And it's this system of care that achieved the ACTION Registry Platinum Performance Achievement Award from the National Cardiovascular Data Registry earlier this year.

The designation, awarded annually to hospitals across the country, honors systems of care which consistently meet or exceed national standards.

In practice, this means the cardiac team at Kalispell Regional works like a well-oiled machine. If, for example, the national guideline for the length of a stent procedure is about 90 minutes, then the team at Kalispell has smoothed the process so that "our time here is on an average 58-60 minutes," said Dr. Mayank Agrawal of Rocky Mountain Heart and Lung. "And there is not even one patient whose care has been beyond 90 minutes."

The Platinum distinction, he said, recognizes "the system that has been put in place which involves coordination with the EMS, the ALERT helicopter, the emergency room, the cardiologists, the cardiac nurses, the cardiac rehab, the case coordination and our cardiology clinic.

"This award is a representation of the hard work and the efforts put in by people in all these categories to get to a place where ... having a patient with a heart attack come here, it's not a big event. It's a day-to-day thing."

Day-to-day was how Blood regarded his cardiac health before he went from former rehab patient to an emergency case in May. Having previously received a stent and gone through cardiac rehab at The Summit, he has been involved at most layers in the cardiac care process.

For the 10 years following his stent procedure, things went smoothly. He exercised regularly, no complications. But over the course of a few days in May, he developed pain in his chest.

"At first, I thought it was lungs," he said. But in the middle of the night, he realized the condition was far more serious. "It really got me on the right side."

His trip to the ER triggered a chain of care whose success depends on cooperation and timely response of each link, whether it's a one-in-a-thousand issue or a "day-to-day" heart attack.

"We knew him and as soon as called the EMS he came to the hospital, his heart attack was recognized by the emergency room physicians," said Agrawal. Within 10 minutes of arriving, hospital staff conducted an EKG test, which identified Blood's acute heart attack. This "activated the cath lab" -- the call that summons surgeons such as Agrawal and the Rocky Mountain medical staff in to the hospital.

Agrawal and his team, summoned at 1:30 a.m., successfully unblocked Blood's artery through a series of stents. Then, he was passed along to post-op care.

"Once the stents were put in he was sent to the floor, he was started on the right medicines, he was recommended for cardiac rehab, which is an essential part, and then he was discharged."

The chain still continues weeks later, as he works out at The Summit with the rehab team.

Blood's case, said Agrawal, "represents a very good example of how the layers in the system work, which involve all these different [people]."

Though many would view exercise as a chore, especially following two heart procedures, Blood expressed satisfaction with this last step in the chain. "I enjoy coming here," he said.

"Every day is a good day."

As for the cardiac team aroused in the middle of the night to save his life, Blood said, "At 2:30 in the morning, they took care of everything. Dr. A, who I've gotten to know, arrived. Basically, he saved my life. Not basically, he did."

Agrawal is quick to attribute credit to the many medical staff who work in the process with him. And though he said he'd much rather be sleeping at 2:30 a.m., "This is what we live and die for. This is what we train for. When we train for these emergencies, we do so many of these procedures over the years that it becomes a reflex. We don't have a second thought. When we get a call, we get in the car -- and when I say we, it's not just the doctor. It includes the cath lab nurses, the cath lab techs...We don't ask a second question.

"We come here and we just see the patient and take them in and do what's right for the patient. It's part of the job and we take pride in it."

Reporter Adrian Horton can be reached at ahorton@dailyinterlake.com or at 758-4439.

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