Welcome to the Becker's Healthcare podcast. I'm Mariah
Taylor, assistant editor, and I'm thrilled to be
interviewing Greg Reese, an interventional cardiologist at UPMC
on the podcast today. Greg, thank you so
much for joining me. I'm really excited to
talk more about the work you're doing in
cardiology care. But before we dive into that,
I'd love you to introduce yourself and tell
us a little bit about your background.
Oh, thank you, Mariah, very much, for having
me on the podcast.
Well, let's see. I, grew up in New
York City. I went to Penn State,
went to Cornell Medical, and did my,
residency fellowship training in Boston at Beth Israel
Hospital.
I practiced in Philadelphia for many years and,
came to South Central Pennsylvania about eight years
ago.
Excellent.
Now I hear that you over there at
UPMC are doing some really interesting stuff in
STEMI. So can you walk us through how
the STEMI system is working?
Of course. Well, we have a, STEMI alert
system as, you know, most hospitals,
do that have on-site interventional cardiology.
And the way it works is we have
a interventional cardiologist,
at our hospital,
all of our hospitals, but mine in particular
is is here in York, Pennsylvania.
We have, an interventional cardiologist on call 247,
always within thirty minutes of the hospital.
We also have,
cardio cardiovascular
technicians and nurses,
also within thirty minutes of the hospital,
on call twenty four seven. So
if a patient comes into the ER
or if the EMS team alerts us that
they have a STEMI in the field,
we have both activation both via cell phone
and via,
pagers. You know, the nineteen eighties are calling,
and they want their technology back.
But we have that as well because there
are some, dead zones where cell phones don't
work.
So we have multiple, modes of alert, and,
you know, the team, mobilizes
and comes in. You know, our goal, of
course, is to be in within thirty minutes
and,
to have the patient in the cath lab,
on the table, getting the procedure, and have
the,
artery open, ideally within thirty minutes after that.
There is a ninety minute,
goal, by the
ACC,
door to balloon time. We we want, to
exceed that goal,
as much as possible, and that's, that's how
we work in the hospital.
Amazing. And I hear that you've done exactly
that. Can you tell us a little bit
more about the case where you were able
to get a patient in in a thirty
seven minute window from door to balloon time?
Of course. Now that was a off hours
case.
So thirty seven minutes is, certainly,
very doable if, you know, the team is
all there. It's 10:00 in the morning. You
have an open lab, and someone comes into
the ER. ER identifies the patient quickly as
a STEMI does a quick EKG,
you know, the cath lab team can swoop
over,
grab the patient, get them on the table,
and that's doable. What was unique about this
case is it was an off hours case.
So the key here was that the patient
called EMS,
that the EMS,
providers,
who we work closely with, you know, I,
did an on-site EKG,
that was
sent to the coordinator,
team in the ER, and the STEMI alert
was called from the field. So we had
time as a cardiology team to get in
the hospital and get ready and basically to
meet the ambulance,
at the door.
So that way we were able to, you
know, get the patient
in through the ER as quickly as possible
on the table, instrumented,
and get a door to balloon time of
thirty seven minutes.
That's incredible.
And I'm sure as our listeners picked up
too, there really is this emphasis on your
team. So can you explain a little bit
more about how your team has prepared and
trained for exactly this kind of case and
how you're coordinating with other teams?
Absolutely. I mean, I think, you know, the
emphasis,
in STEMI care, if you're talking about even
ACLS training, has been the importance of the
team. It's not one person. It's not a
cardiologist. It's not an ER doc, but it
requires a whole, you know, whole village. You
know, it starts with the, the EMTs who,
you know, can get there,
identify the patient with chest pain, do an
on-site EKG,
and and call the STEMI alert. It's the
ER docs who,
and not only the ER docs, but the
ER nurses,
you know, everyone from the front desk,
to the nurses to the doctors,
who can rapidly
triage those patients and and get, get them
cared for. And then it is, you know,
cardiology team. And then after we're done with
the patient, it's the,
doctors and nurses in the ICU. So it
really is a team effort to get the
best results, not only in door to balloon
time, but also in outcomes, patient satisfaction, etcetera,
in the care of STEMI patients.
Excellent.
And it's clearly paying off because UPMC Memorial
and UPMC
Hanover have both earned the ACC Platinum Performance
Achievement Award for five years in a row.
So can you talk to us a little
bit more about what you believe has contributed
to that streak?
I think what has contributed
is that it's been a priority
of the individual hospitals and more importantly of
the UPMC
system,
to provide excellent quality care across the cardiology
spectrum,
in terms of STEMI care,
congestive heart failure, other conditions.
The platinum award,
which, you know, we really do value is
a recognition
of that of that care. You know, we
achieve that by
analyzing all of our outcomes, you know, with
a very critical
viewpoint to continuous quality improvement.
You know, we have meetings,
once a month or more, you know, more
often if necessary,
where we analyze all the cases,
all of the, STEMI cases where we analyze
our outcomes in cardiac catheterization,
heart failure, arrhythmia management, etcetera,
looking for any ways in which we can
improve. You know, improvement doesn't take place in
leaps and bounds. It takes place in small
steps. You know, you you get a an
average time of
ten minutes to EKG down to seven minutes,
and you get,
a minute here, a minute there.
You get more thorough administration of medications in
the ER and administration of medications at discharge,
to prevent readmissions. So, you know, again, it's
a it's a team approach, but it really
is a dedication
to, continuous improvement and optimizing care.
Excellent.
Well, thank you so much for taking the
time to speak with me today. This was
such an informative discussion.
Thank you. Thank you for having me.