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WINTER 1995 ISSUE
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SINAI HOSPITAL
HealthNews
When Minutes Count:
Taking Chest Pain
f
Seriously
The sirens wind
down and the flashing
lights stop,
as the ambulance carrying
a woman suffering chest
pairtpulls up to the Sinai
Hospital Emergency
Room. The intense ener-
gy of emergency med-
ical intervention of the
streets is transferred to
Sinai's cardiac response
team, that stands ready to
accurately diagnose and ap-
propriately treat chest pain 24
hours a day, every day.
"Minutes count when a patient is
undergoing a heart attack," says
Cardiovascular Disease Section
Chief Stephen Gunther, M.D. "The
sooner the patient gets treatment,
the better the chance for a success-
ful outcome."
Recognizing the simple truth that
time is especially critical in response
to a cardiac emergency, Sinai Hos-
pital has designated a special four-
bed area in the middle of the emer-
gency room as a "Chest Pain Cen-
ter." This centrally located area has
the appropriate personnel and
equipment ready to receive, diag-
nose and treat the patient with chest
pain immediately.
"Only one in six chest-pain
patients in the US who is a candi-
date for specific life-saving cardiac
therapy gets the appropriate treat-
ment," Dr. Gunther reports. Unfor-
tunately, traditional blood tests can
be misleading and EKG's can result
in false negatives.
"At Sinai, we have far more so-
phisticated tests available within a
rooms is 60 to 90 minutes. Sinai
finds that leng thy timetable unac-
ceptable for a patient in cardiac dis-
tress who can be lost in a heartbeat.
"When a chest-pain patient arrives
at Sinai, the patient is brought to the
cardiac critical care section in our
emergency room where, within a
short time, the patient is monitored,
receives oxygen, has an IV [intra-
venous line] started, and has blood
tests and an EKG done," says
William P. Aurich, D.O., Chairman
of Sinai's Department of Emergency
Medicine.
"We are dedicated to providing
rapid, expeditious, courteous care by
highly trained emergency physicians
and nurses, who keep the family
informed," he continues.
When the tests are completed, the
team is ready to provide the appro-
priate treatment, based on the re-
sults. If anti-clogging drugs will do
the job, they are administered im-
mediately. If the tests reveal a need
for balloon angioplasty or other more
complex treatment, that too can be
v e are dedicated to providing rapid, expeditious,
"We
courteous care by highly trained emergency
S PEC IAL ADVERTI SEM ENT
physicians and nurses, who keep the family informed."
short time. In addition to highly
qualified cardiac physicians and
nurses, we have specially trained
technicians and pharmacists on
hand to move us toward our goal to
provide the appropriate therapy
within 30 minutes to 100 percent of
those who can benefit."
The 30-minute goal is exception-
al, as the average response time to
heart attacks in most emergency
accomplished by a skilled physician
who is readily available.
Considering the critical time fac-
tor, Dr. Aurich would like to remind
people that an effective emergency
response process begins with the pa-
tient and his or her family and
friends. "If you have chest pain, don't
sit at home waiting for it to go away,"
he cautions. "Get yourself to the
nearest emergency room."
Take Heart: Sinai Offers Package
Pricing, Superior Service
inai Hospital's cardiovascu-
lar program has switched on
a light that will lead the way
for Michigan hospitals. The chal-
lenge Sinai has accepted — and met
— is to make a commitment to re-
duce costs, while maintaining high
quality care.
Known as package pricing, the
idea means that patients can ben-
efit from a broad spectrum of com-
prehensive services for one flat fee.
Consider, for example, bypass
surgery. First, catheterization and
pre-treatment care are performed;
then surgery, post-operative fol-
low-up, highly skilled nursing and
therapeutic care are delivered.
S
more expensive because they re-
quire more treatment and, there-
fore, are more expensive for the
provider."
"One way to assure good out-
comes after shorter hospital stays
is to increase the nurse-to-patient
ratio," explains Eric C. Hanson,
M.D., Acting Chairman of Car-
diovascular and Thoracic Surgery
While typically one nurse is re
sponsible for four or five patients,
Sinai's cardiovascular surgery
step-down unit will assign only
three patients to each nurse. 'The
result is better nursing care. The
patient reaches post-operative
milestones sooner and is ready to
;Surgeons at Sinai are
complemented by a
caring. professional
surgical nursing staff
Finally, there may be a need for
home nursing.
Imagine the price for all of these
services and anything else re-
quired along the way fixed at a sin-
gle, predetermined fee. That is the
concept Sinai is proposing to a
number of insurers so that heart
surgery patients have cost-effec-
tive access to the finest treatment
by a team of highly skilled, effi-
cient health care professionals.
"Efficiency is the key," says
Steven L. Rabinowe, M.D., Chair-
man of Sinai's Department of
Medicine. "Package pricing moti-
vates us to achieve the best possi-
ble outcome with efficient use of
resources. Unnecessary testing,
for example, makes no sense un-
der the package pricing concept.
And, ultimately, poor outcomes are
.
go home in a shorter period of
time," he says.
'We find that the patient does
not simply occupy a bed, waiting
to get well. Instead, each patient,
with the direction of the staff, is
expected to meet specific recovery
objectives each day," Dr. Hanson
explains.
Those objectives are established
in a carefully defined critical path-
ways primer created for each
patient. "Everyone involved with
the patient — including the respi-
ratory therapist, nurses and res-
ident physicians — knows what
progress is expected of the patient
every day," Dr. Hanson says.
Each activity, from getting out
of bed and into a chair, to having
chest tubes and other catheter
continues on page 6