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The Honolulu Advertiser
Posted on: Monday, February 27, 2006

Heart patient transfers speed up

By Kevin Dayton
Advertiser Big Island Bureau


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WAIMEA, Hawai'i A project started last year to move heart attack patients more rapidly from the Neighbor Islands to specialists on O'ahu appears to have shaved about a third off of the time required for such transfers, according to officials with two hospitals involved in the project.

Dr. Gary Goldberg, an emergency room doctor and medical director for North Hawai'i Community Hospital, said he is confident the project will save lives because it helps rush stricken patients more quickly to The Queen's Medical Center for the specialized care they need.

"I can think of one case that took 24 hours, and we don't have that any more," Goldberg said. "This is a first step to improving care, and it's an important step, because these are people who are critically ill."

The idea for the project grew out of a partnership between The Queen's Medical Center and the North Hawai'i Community Hospital in Waimea on the Big Island.

The partnership is part of the Waimea hospital's Hawai'i Heart Brain Center, an initiative to upgrade the level of hospital services available for heart and stroke patients at the hospital, and to launch new screening and prevention programs for the 30,000 rural residents the hospital serves.

Early on doctors raised the alarm at delays as long as 24 to 48 hours in moving heart attack patients into the specialized treatment beds at Queen's.

North Hawai'i and Queen's gathered data for cardiac patients transported from the Big Island to O'ahu from January to April 2005, and concluded there was room for improvement.

One case took only three hours to get from North Hawai'i to Queen's, a particularly quick movement made possible when an air ambulance happened to be in the right place at the right time. Several other cases averaged about four hours and 20 minutes to make the trip.

More troubling was another cluster of cases where it took an average of 17 hours to get from Waimea to Queen's; and two other cases, one took 24 hours to make the trip, and another took 48 hours.

At first the staffs at the two hospitals pointed fingers at each other and at the air ambulance company that transports the patients, but studying the transfers revealed the air ambulance company was responsible for only about four to six hours of the delays, said Dr. Kenneth Riff, executive director of North Hawai'i's Heart Brain Center.

The reality was North Hawai'i was spending too much time deciding who would be transferred, or seeking out the right people at Queen's to authorize and co-ordinate the transfer.

At Queen's, patients were sometimes delayed in the emergency room before moving them into the right therapy beds.

"It was a bunch of internal things. The reality was, sure, every once in a while the air ambulance system would get backed up or the weather would get bad, but you know what? That wasn't the problem in the vast majority" of the cases, Riff said.

"It was things we had complete control over, and once we realized it was things we had complete control over, we worked together to fix those things," he said.

Queen's established a Cardiac Transfer Center last September with a cardiac nurse on duty at all times, and a single telephone number Neighbor Island doctors could call to coordinate heart attack patient transfers.

Queen's also made a commitment to make a bed available for every transfer request, an important step because in the past Queen's would sometimes delay transfers when its cardiac beds were already full, said Cathy Young, a registered nurse at Queen's and vice president of patient care services, cardiac medicine and geriatrics.

Since making the system improvements, Young has tracked 247 cardiac transfers from all over the state.

The fastest interisland trip was made in three hours and 37 minutes. The longest was 23 hours and 30 minutes from the Big Island. The average time for transporting patients now is about eight hours, and the median the point where half the cases move faster and half are slower is four hours, she said.

"We've been able to make a difference in improving that time, and we've been able to do it because a team focused on it," she said.

In an apparent side effect, cardiac transfers from the Neighbor Islands have increased by about 25 percent this year over the same period last year, which Young said may be because the transfer process is getting easier for everyone.

Reach Kevin Dayton at kdayton@honoluluadvertiser.com.