Chest Pain : New Center at Hospital Promises Fast Action; Critics Says It’s Merely Clever Marketing of Common Service

Scott Miller was driving home from work on the San Diego Freeway when he first noticed the pain in his chest.

It was a squeezing sensation that pressed sickeningly on the inside of his breast, scaring the wits out of the 33-year-old financial consultant. He took the next exit and drove to the emergency room of Long Beach Memorial Medical Center, the nearest hospital.

Miller said he was met by a nurse who took him into a special room, assessed his condition and almost immediately began administering a drug that eventually alleviated the pain by easing the flow of blood to his heart. Four days later, after 72 hours in intensive care and numerous tests to determine the cause of the apparent temporary arterial blockage that had caused the pain, the young Long Beach resident was cheerfully preparing to go home.

“He could have had a big heart attack,” said Dr. Myrvin Ellestad, medical director of the hospital’s Heart Institute. “It’s very likely now that he won’t get into serious trouble.”

Miller was treated at the Memorial Chest Pain Center, a new facility at the hospital. Depending on who is doing the talking, it is either a program that is one of the first of its kind in the country, or a smart marketing technique that essentially duplicates the services of other hospitals, but with much more hoopla.

Located in a specially designated room of the hospital’s emergency department, the chest pain center consists of four beds equipped with heart monitors. It is attended 24 hours a day by a team of specially trained nurses, with a group of cardiologists on call. Here, program administrators say, anyone complaining of chest pains will be seen within 10 minutes and tentatively diagnosed within 20. Treatment will be started, they promise, within 40 minutes.

Early attention is crucial, Ellestad said. More than a million Americans die of heart attacks each year, he said. Although many heart attacks are marked by chest pains, he said, the average heart attack victim waits three hours after the onset of the pain before seeking medical attention. And even when they finally make it to an emergency room, he said, patients complaining of chest pains are often given low priority compared to trauma patients with more visible bleeding wounds, such as those caused by gunshots or automobile accidents.

Years ago, immediate treatment was not as critical, doctors say, because about all they could do was make their patients comfortable and hope for the best. But with the recent development of medications and surgical techniques that, when applied early, can dramatically reduce the blockages in arteries that cause heart attacks, Ellestad said, time is of the essence. If a heart attack has not yet occurred, he said, it can sometimes be prevented. And if the patient has already had a heart attack, he said, early treatment can minimize the permanent damage to the organ, which would make future attacks less likely.

30 Patients a Week

In the three weeks since the center opened, Ellestad said, its nurses and physicians have seen an average of 30 patients a week, about 30% of whom had actually had heart attacks. By increasing the rapidity of its service to such patients, he said, the hospital hopes to reduce its mortality rate for heart attack victims from the current 10% to about 5%.

“If you sit at home (when you have chest pains) you’re going back to 1960 medicine,” said Tammy Florio, a cardiac nurse and vice president of the hospital’s heart institute. “It’s like seeing someone drowning in a pool and not helping them.”

Getting that message out and delivering on it is costing the hospital money. According to Florio, Memorial has budgeted $240,000 the first year for extra nurses to staff the chest pain center at 2801 Atlantic Ave. In addition, she said, the hospital plans to spend $87,000 on an aggressive publicity campaign consisting of 85,000 mailers, 10 public billboards, a series of newspaper ads and a speakers bureau.

Patients who use the center, she said, will be charged regular emergency room rates in addition to the charges for whatever specialized treatments they receive. Eventually, she said, administrators hope the new center will become profitable by generating a high patient volume.

Creative Marketing

Detractors say that is the whole point. Like other area hospitals, Memorial has experienced a decline in patient admissions--8.7% in the last year. In the current atmosphere of increased competition for patients among area hospitals, critics say, this one has found a creative new way to market its emergency services.

“I would be willing to say that almost anybody could duplicate the time” promised by Memorial in diagnosing and treating patients complaining of chest pains, said John Senteno, nursing director in the emergency department at nearby St. Mary Medical Center.

At his own facility, Senteno said, patients are greeted in the waiting room by nurses who immediately assess the seriousness of the patients’ conditions and, in the case of possible heart attack victims, send them without delay into the emergency unit for treatment.

“I can’t imagine any emergency physician in this day and age allowing someone complaining of chest pain to sit unattended for any length of time,” Senteno said. “It would be too risky not to heed that complaint.”

‘That’s a Priority’

At Long Beach Community Hospital, according to Annette Kashiwabara, public relations coordinator, patients complaining of chest pain are routinely seen in 10 minutes or less. “As far as assessing chest pain,” she said, “that’s a priority at this hospital, too. It’s just that we don’t brand it. (What Memorial is doing) is a very smart marketing strategy.”

Whatever the motivation for creating it, some patients who have been through the new center give it rave reviews.

Edwin Reeves, a 78-year-old retired Methodist minister, began experiencing heavy chest pains about 11:30 p.m. Aug. 19 as he lay in bed next to his wife. After waiting “a little while to make sure that I wasn’t having indigestion,” Reeves said, he woke up his wife who drove him to Memorial Medical Center, where the pain was diagnosed as a heart attack and Reeves was scheduled for surgery.

“Everything would have happened much slower without the center,” he said from his hospital bed. “The help guaranteed that I was given an extension of life.”