Tens of thousands of patients walk into Texas hospitals with heaving chests and sweaty brows, wondering if they’ll ever walk back out the door. Those who come to University Hospital’s Cardiac Intensive Care Unit (CICU), directed by David McCall, M.D., Ph.D., probably will.
That’s because the CICU he runs has the lowest myocardial infarction (heart attack) mortality in the entire South Texas region. It has one of the lowest rates in the state of Texas.
The numbers are published in a report from the Texas Health Care Information Council. According to the study, Texas hospitals averaged a 10.4 percent mortality rate. The CICU had a 2.7 percent observed mortality rate in 2000, which is the most recent compilation of figures.
The CICU’s secret? Teamwork. "Our success is due to the efforts of Dr. McCall and his team approach to patients," said Gregory Freeman, M.D., division chief and professor of cardiology.
Dr. McCall, also a professor of cardiology at the Health Science Center, created a coronary care game plan that rivals the organization of any major-league sports team. The plan is complete with the athletes (highly trained doctors and nurses), a back-up team (residents and fellows ready to initiate care 24 hours a day), and post-game follow-up (pharmacological treatment and rehabilitation therapists). The result is a well-choreographed team attack on heart attacks. "We’re multifaceted, but we are really well integrated," Dr. McCall said.
The cohesiveness is apparent the instant a patient enters the emergency room. "We are very aggressive in taking patients to the catheterization lab when they first present. We have a lot of cooperation between our Coronary Care Unit, interventional cardiologists and cardiothoracic surgery," Dr. McCall said. "Our aim is to have the artery open within 90 minutes (a standard guideline for cardiac care). We can often do it in around 30 minutes. That makes all the difference."
It made a tremendous difference to Kay Allen. The 46-year-old diabetic suffered chest, neck and back pains last October, but the words "heart attack" never crossed her mind. "I was extremely uncomfortable, but I thought it might be something with my gallbladder since I had other health problems," Allen said. "When I got to the hospital, they took me right in, hooked me up to a bunch of machines and right away said I was having a heart attack."
Allen was shocked. "I thought it was bad. I thought I’d be sick the rest of my life," she said. "It happened so fast, but Dr. McCall was really thorough." One stent and four days later, Allen went home from the hospital. "No one ever rushed me and everyone took really good care of me," Allen said. "I’m just so thankful. This really was a miracle."
A miracle for Allen, but the results of a well-executed plan by Dr. McCall. "We have a lot of advantages that other hospitals don’t have. Because we are a teaching hospital, physicians, senior residents and fellows are on site 24 hours a day," Dr. McCall said. "We also have a terrific nursing staff. We couldn’t take this approach without them."
Dr. McCall’s approach also includes strict adherence to medically established guidelines for treating heart attacks. Not only does his team meet or exceed the 90-minute guideline for opening an artery, pharmacologists recorded some of the best compliance rates in the nation for post-myocardial infarction drug treatment.
"The American Heart Association and the American College of Cardiology jointly established guidelines for heart attacks," said Robert L. Talbert, Pharm.D., professor of pharmacy, pharmacology and medicine. "The rate of recurrent heart attack and stroke, as well as the risk of developing heart failure, are all increased if we don’t follow these guidelines."
So at the end of the day, doctors usually place another mark in the "win" column at the CICU – not that Dr. McCall is keeping track. "We just want to do the best job we can for all the patients who come in. In the ideal world, we’d save them all and the mortality would be zero," Dr. McCall said.
"But the national average is a 5 percent to 6 percent mortality rate. The average for Texas is 10.4 percent and ours is 2.7 percent. So I am really gratified by our results."
The results of the report are available at www.thcic.state.tx.us. But those are just figures. Allen and hundreds of others in San Antonio are the living proof of the CICU’s success.