How Our Cardiac Catheterization Rapid
Response Team Operates During Off-Hours
This article originally appeared in Pathways,a magazine
published for physicians and the community by UMass Memorial
One of the key contributors to the outstanding door-to-balloon times
for ST-elevation myocardial infarction (STEMI) patients at
UMass Memorial Medical Center was the refinement of how its Cardiac
Catheterization Rapid Response Team operates during off-hours.
Cath Lab had an on-call component for years to cover nights,
weekends and holidays," said Jay Cyr, RN, MS, MBA, vice president
of the Heart and Vascular Center of Excellence. The lab's regular hours are
Monday through Friday, 7 am to 7 pm.
"But in the past, if a patient with chest pain arrived in the Emergency
Department during off-hours and needed catheterization, the ED
physician first had to call a cardiologist who would then activate the on-call
catheterization team," he continued. "That process could take
upward of three hours.
"We realized we needed to dramatically change the process," Mr.
Cyr added. "When time is of the essence, why were we doing
sequential things when it made more sense to do them simultaneously?"
Technology now makes it possible for paramedics to transmit a patient's
EKG from the ambulance to the ED. Operational changes at UMass
Memorial not only give the ED attending the authority to activate the
Cath Lab but also to send an incoming STEMI patient
directly to the lab, bypassing the ED.
"Now, paramedics are transporting a patient at the same time that the
cath team is coming in," Mr. Cyr said. "And because it
takes an average of just 25 minutes for the on-call team to get here, it is
often waiting for the patient in the Cath Lab. It's been a huge
The on-call rapid response team
consists of a cardiac interventionalist, an
interventional fellow, two nurses and one radiologic
technologist. Team members who can reach the hospital within 20 minutes of
activation report directly to the Cath Lab to prepare for the
STEMI patient's arrival. Upon arrival, other members of the team
are directed to either the ED or Cath Lab, depending on the
The UMass Memorial Life Flight and EMS communication
center automatically follows up to verify activation of all team members, and it
facilitates communication between the physicians, nurses and technologists as
they travel to the Cath Lab.
"We've gone from patients arriving in the ED and being seen by two sets
of doctors to having the cath team activated and ready before the
patient even arrives," Mr. Cyr added. "It's a huge leap that
benefits patients tremendously."