Emergency cardiac care program keeps getting stronger

Improved repatriation process returns patients to their home communities, facilitates continuity of care and ensures access to emergency cardiac services for future patients

As a leading member of the Toronto Heart Attack Collaborative (THAC), Rouge Valley’s cardiac care team was one of the key presenters at the collaborative’s city-wide Code STEMI Conference, held in September.  Code STEMI is a life-saving program that fast-tracks heart attack patients to the closest cardiac centre where they can receive the required intervention, which may be a coronary angioplasty. The gold standard is to treat patients within a 90-minute window. Rouge Valley Health System (RVHS) delivered two presentations at the THAC conference: cardiologist and medical manager of interventional cardiology Dr. Saleem Kassam spoke on the continuum of care framework; and registered nurses June Thomas, Kathy Grunberg, and Andrea Allen presented on repatriation of Code STEMI patients to the hospital closest to where they live.

Rouge Valley’s relationships with all of its partners is a critical success factor, not just with respect to saving lives, but also in terms of sustaining the fast-track emergency cardiac care system as a whole. This was highlighted by Rouge’s presentation on repatriation, which looked at process improvements that have been made to facilitate the return of patients to their local hospital after they have been brought to Rouge Valley through the Code STEMI program for an emergency procedure.

When Code STEMI was first implemented in fall 2009, the main concern was ensuring that the partnering organizations could get patients to the cath lab at Rouge Valley Centenary (RVC) within the targeted window of time. This has been working successfully. To sustain the capacity needed to treat emergency patients coming from throughout Scarborough and as far away as Bowmanville, and provide elective services for cardiac patients who have scheduled procedures, the repatriation (the return of successfully treated Code STEMI patients from RVC to their local hospital) must occur smoothly. Repatriation allows patients to recover in their home communities, thus facilitating continuity of care, and ensuring there is space at RVC to take on new patients.

“We always need to have our door open and beds available. That is why getting repatriation of patients right is so important,” says Evangeline Andaya, manager, cardiac catheterization lab. “We are working more closely with our partners at Lakeridge and The Scarborough Hospital to facilitate repatriation. We looked at all of the processes—clinical and administrative— to determine gaps and opportunities for making the system as a whole better. Developing standard practices like these is how we are continuing to enhance our quality of service.”

Repatriation of patients is not a unique issue. Many similar Code STEMI programs and regional services face the same challenges. Thanks to
improved processes in repatriations, Rouge Valley has increased its capacity to provide cardiac care services. The THAC conference was a chance to share some of the lessons that RVHS and its partners have learned along the way.

“Repatriation helps us to achieve two important goals. The first is improving patient flow, thus ensuring access to emergency cardiac care for Scarborough and Durham. The second goal is facilitating the continuity of care from hospitals back to the community health care settings. Its much easier for this to happen when patients are at a hospital that is close to their homes and to their family physicians and cardiologists,” says Dr. Kassam. “This was truly a collaborative effort, in which all of the partners are working towards streamlining processes with best patient care in mind.”

THAC is a joint initiative between Toronto Emergency Medical Services (EMS ) and hospitals across the GTA, which supports Code STEMI programs. Rouge Valley became a part of the collaborative when the hospital was approved by the Central East Local Health Integration Network (CE LHIN ) to serve as the regional centre for Code STEMI services for Scarborough and Durham. RVHS provides Code STEMI services in partnership with Toronto EMS , Durham Regional EMS , and The Scarborough Hospital and Lakeridge Health.

This article first appeared in Rouge Valley's Fall 2012 Echo newsletter and was written by Rouge Valley's Coordinator of Corporate Communications, Nicholas Smith.