Clinical Quality

In two critical areas of heart care – heart attack and heart failure – St. John’s Mercy meets or exceeds the Centers for Medicare and Medicaid Services (CMS) national quality measures for the following best practices:

Heart Attack

• ACE (angiotensin converting enzyme) inhibitor or ARB (angiotensin receptor blocker)
• Beta blocker at arrival and discharge
• Aspirin at arrival and discharge
• PCI (percutaneous coronary interventions) within 120 minutes of arrival*
• Smoking cessation advice/counseling

*See more below under Door-to-Balloon Time

Heart Failure

• Assessment of left ventricular function (LVF)
• ACE inhibitor or ARB
• Discharge instructions for heart failure patients

Door-to-Balloon Time: Faster Interventions through Code STEMI

“Our goal is to improve clinical outcomes by significantly reducing time to treatment during the critical early stages of acute myocardial infarction.”

George M. Kichura, M.D., FACC
Medical Director of the St. John’s Mercy Cardiac Catheterization Laboratory

According to the New England Journal of Medicine, patients suffering heart attacks who receive care within 90 minutes fare better than those who do not. However, only about 35 percent of hospitals nationwide have adopted time-saving procedures to achieve this standard of care. St. John’s Mercy Heart and Vascular Hospital, which treats more than 2,300 patients each year for chest pain, heart attacks and related procedures, is one of them.

As a result:

• For the most recent quarter reported, St. John’s Mercy ranks in the top 10 percent in the nation in door-to-balloon time (or the amount of time it takes for heart attack patients to receive emergency intervention such as balloon angioplasty).
• St. John’s Mercy’s median door-to-balloon time has been consistently under 90 minutes since July 2006, as opposed to the 120-minute standard still accepted in many hospitals .
• When patients present directly at St. John’s Mercy, even faster interventions are regularly performed.

In July 2006, a multidisciplinary cardiovascular team at St. John’s Mercy implemented code STEMI – a process that improves clinical outcomes for heart attack patients by facilitating rapid intervention. STEMI stands for ST-Segment Elevation Myocardial Infarction, the medical indication that a heart attack has occurred.

Code STEMI automatically sets a chain of actions in motion including treatment team communication, emergency department (ED) preparation and cardiac team assembly. It begins when electrocardiogram (EKG) results are transmitted via radio link from ambulances and medivac helicopters to the St. John’s Mercy ED. Once a diagnosis of code STEMI is made, the ED staff notifies the catheterization laboratory (cath lab) and heart specialist. A team immediately mobilizes to expedite the transfer of the patient to the cath lab for heart-saving interventions such as emergency balloon angioplasty. These actions save lives when you consider that mortality risk nearly doubles when care is delayed past 90 minutes, jumping from 5 to 9 percent, and increases further with each passing hour.

Chest Pain Evaluation Unit is Accredited by the Society of Chest Pain Centers

The St. John’s Mercy Chest Pain Evaluation Unit (CPEU) provides rapid assessment and diagnosis of acute coronary syndromes. The CPEU is accredited by the Society of Chest Pain Centers – a professional society dedicated to patient advocacy and focusing on ischemic heart disease. Located within the Heart and Vascular Hospital, the CPEU offers all private rooms and is separate from the hospital emergency room. Our experienced cardiologists and nurses provide specialized care in an environment that is dedicated to cardiac evaluation.

Nuclear Cardiology Laboratory is Accredited by the Intersocietal Commission for the Accreditation of Nuclear Medicine Laboratories (ICANL)

The St. John’s Mercy Nuclear Cardiology Laboratory provides a full range of diagnostic testing to evaluate cardiac perfusion, function and other clinical conditions. The laboratory is accredited by the Intersocietal Commission for the Accreditation of Nuclear Medicine Laboratories (ICANL) and is one of the first laboratories to earn this accreditation in the United States. ICANL is an independent, nonprofit organization that recognizes diagnostic quality in nuclear cardiology and nuclear medicine through a voluntary accreditation process.

Integrated with a Level I Trauma Center

Located on the ground floor of St. John’s Mercy Heart and Vascular Hospital is the St. John’s Mercy Emergency Department (ED) – part of the only Level I Trauma Center in St. Louis County. The close integration of emergency and cardiovascular services provides patients with the best opportunity for a positive outcome. The St. John’s Mercy ED handles a major share of the county’s trauma cases and provides medical direction for:

• Six fire and ambulance districts
• Four emergency medical response agencies (EMRAs)
• Arch Air Medical Service, the leading critical care air transport service covering Missouri, Illinois and the surrounding region.

Quality Awards and Recognitions

St. John’s Mercy has earned local and national recognitions for improving clinical quality and achieving high levels of patient and staff satisfaction.

• St. John’s Mercy ranks among the top 10 percent of hospitals in the nation in:

• Composite scores for national quality standards
• “Door-to-balloon time,” or the amount of time it takes for heart attack patients to receive emergency care such as balloon angioplasty.
• Stroke care among Medicare providers (and also ranks in the top three in the state for stroke care)
• Applying all standards of care that prevent surgical site infections.

• St. John’s Mercy’s bloodstream infection and ventilator-associated pneumonia rates are below national averages and remain consistently low.
• St. John’s Mercy ranked best in patient satisfaction among hospitals in the St. Louis area, according to scores released in March 2008 by the U.S. Department of Health and Human Services.
• Modern Healthcare named St. John’s Mercy among the 100 Best Places to Work in 2008 based on an analysis of eight core areas: leadership and planning, culture and communications, role satisfaction, working environment, relationship with supervisor, training and development, pay and benefits, and overall satisfaction.
• The St. Louis Business Journal named St. John’s Mercy a first-place recipient in the 2008 St. Louis“Best Places to Work in St. Louis” Awards, in the category of 2,000+ employees and a 2009 "All Star" Best Places to Work Recipient.
• Primaris Hospital Quality Award – Only one hospital in the state is recognized annually by Primaris, the Medicare Quality Improvement Organization for Missouri. St. John’s Mercy Medical Center was the 2006 Primaris Award recipient for achieving high performance in national standards of quality care and for its accomplishments in improving clinical outcomes. St. John’s Mercy Hospital in Washington, Mo., received the award in 2005.