Kaiser to join L.A. County transfer network for heart attack care
Amid concern among some experts that the healthcare giant had been slow to act, Kaiser Permanente has announced it will join a Los Angeles County patient transfer network that quickly gets victims of severe heart attacks to specially equipped hospitals to reduce chances of serious complications or death.
The transfer system allows emergency departments to use the 911 medical response network to rapidly shift the patients to nearby facilities prepared to perform immediate angioplasty procedures that open blocked blood passages.
Emergency departments at Kaiser’s eight Los Angeles County hospitals, which served 467,000 patients last year, were the only ones that had not signed on to participate in the government-run transfer system, opting instead to give clot-busting drugs to most patients as an initial treatment. Kaiser hospitals in other counties have already joined transfer networks.
Dr. Todd Sachs, medical director of operations for the Southern California Permanente Medical Group, said that before making the policy change, his group wanted more data showing that transferring patients was more effective than giving them medication.
Kaiser also wanted to make sure the county’s emergency paramedic-and-ambulance system could transport the heart attack victims fast enough, he said.
“You could say we weren’t first to the table, but our goal isn’t to be first to the table,” he said. “Our goal is to give the best quality of care.”
Dr. William Koenig, medical director of L.A. County’s EMS agency, praised Kaiser’s decision. His agency has been working to get all patients suffering so-called STEMI — or ST-elevation myocardial infarction — heart attacks to special centers that operate cardiac catheterization labs around the clock.
Cost was not a consideration in the decision, Kaiser spokeswoman Peggy Hinz said. On average, Kaiser medical centers see about 50 STEMI cases per center per year, and past patient outcomes have been good, she added.
About a third of heart attacks are STEMIs, which occur when one of the three main arteries bringing blood to the heart is suddenly blocked. The episodes can cause irreversible damage to cardiac tissue, which can kill patients or leave them with chronic heart failure. More than 14,000 Californians had STEMI attacks in 2011, according to federal statistics.
In the 1990s hospitals typically gave such patients drugs, known as thrombolytics, to break up clots that cause heart attacks and restore blood flow to the heart muscle, said Dr. William French, who runs the cardiac catheterization lab at UCLA-Harbor Medical Center.
But researchers discovered that patients had better results when they were treated initially with procedures such as angioplasty, in which doctors insert a catheter and balloon into blocked blood vessels to restore blood flow.
The American College of Cardiology and the American Heart Assn. issued guidelines in early 2013 that called for cardiologists to use such treatments on STEMI victims when they can take place within 120 minutes of an electrocardiogram confirming such an attack. Having a well-organized and speedy system is key because the faster that blood flow is restored to heart muscle, the less damage occurs.
Kaiser officials said the guidelines, issued in January, contributed to the decision last week to join the patient transfer system.
Many emergency departments embraced the approach more swiftly, said cardiologist Ralph Brindis, who is on the task force that writes the clinical practice guidelines. “It’s etched in granite. Moses has brought it down from Mt. Sinai,” said Brindis, who recently retired from Kaiser Permanente in Northern California.
Today, 33 of the county’s 74 emergency departments are in hospitals with around-the-clock catheterization labs. Since 2006, county officials have been working to ensure that STEMI patients treated by emergency responders are taken directly to hospitals with such labs, Koenig said.
But about half of STEMI patients who go to hospitals aren’t driven there by emergency responders. In 2010, the county expanded the effort by encouraging hospitals to use fire departments and other emergency medical teams to swiftly transfer patients to better-equipped facilities.
In the second quarter of 2013, 74 such emergency transfers occurred, and the median amount of time from confirmation of a STEMI to performing the artery-opening procedure was 111 minutes, Koenig said.
Some STEMI patients arriving at Kaiser emergency rooms have been treated in accordance with the new guidelines by being transferred to the organization’s Los Angeles Medical Center in East Hollywood for angioplasty procedures, or occasionally to other hospitals.
Still, Koenig said, the lack of uniformity in Kaiser’s approach to the new guidelines raised concerns among cardiologists working to build the STEMI-transfer system.
In an urban area like Los Angeles where many hospitals can perform angioplasty around the clock, Dr. Ivan Rokos, an emergency physician at UCLA-Olive View Medical Center, said all efforts should be made to transfer patients to dedicated STEMI centers.
He and others involved in developing L.A. County’s STEMI treatment program said they were gratified to hear about Kaiser’s new policy.
“I’m very happy that there’s been this change,” Rokos said. “I just want the system to be improved.”
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