A $12 million expansion of angioplasty services at Thunder Bay Regional Health Sciences Centre will increase the number of procedures performed annually in northwestern Ontario to 900.
Thunder Bay Regional was designated a stand-alone angioplasty centre in 2007 and began performing procedures that year using interventional cardiologists from the Ottawa Heart Institute. Until then, northwestern Ontario patients had to travel to Ottawa or Hamilton for the artery-clearing procedure – often via air ambulance.
The hospital recruited its first interventional cardiologist, Dr. Mark Henderson, in September 2008 and in the year ending March 31, 2010, performed 550 procedures. A second interventional cardiologist, Dr. Ian Billingsley, was recruited this past April and there is already talk of hiring a third physician within the next 18 months.
Thunder Bay Regional has one cath lab now, but also uses a suite in the hospital's diagnostic imaging department to perform angioplasties.
New cath lab
Construction started in April on a second cath lab and an expansion of the hospital's cardiac in-patient unit to accommodate a six-stretcher, short-stay area for post-operative recovery.
"We serve all of northwestern Ontario, so we can't automatically send all of our patients home immediately after having an angioplasty procedure," explained Nella Lawrence, manager of program planning. "This short-stay area will accommodate patients who are required to stay in hospital for 24 to 48 hours."
A short-stay area reduces pressure on the hospital's inpatient beds and allows trained nursing staff to monitor patients before they are sent home. In the absence of a designated short-stay area, the hospital made temporary use of a post anesthetic recovery room to keep an eye of patients following an angioplasty procedure.
The new cath lab and the short-stay area, complete with nursing station, washrooms and showers, should be ready to accept patients by March 2011, following which the hospital's existing cath lab will be retrofitted. By the fall of 2011, the angioplasty program will be equipped with two state-of-the-art cath labs joined together by a shared control room. The short-stay area will be expanded again to accommodate 10 stretchers and a STEMI room will be added for pre-operative care in emergency cases.
"When patients who are experiencing a STEMI are brought into Emergency, we'll move them right up into that area, so critical care nursing staff and physicians can assess and prepare them for the cath lab," said Arlene Thompson, director of medicine and cardiovascular services.
Thunder Bay Regional Health Sciences Centre is one of only three stand-alone angioplasty centres in Ontario, the other two being the Rouge Valley Health System in Scarborough and Windsor Regional Hospital. Otherwise, angioplasties are only performed at designated cardiac centres, which offer a full range of cardiac procedures, including surgery. Currently, Sudbury Regional Hospital is the only designated cardiac centre in Northern Ontario.
"The Rouge Valley Health System, the first stand-alone angioplasty centre in Ontario, was tracked for two or three years by the Ministry of Health and Long-Term Care to ensure they had great outcomes," said Thompson. "Based on their experience and the great need for services in northwestern Ontario, we were approved to run our stand-alone program."
Rave review
In June 2010, an evaluation committee led by Dr. Bernard Goldman of Sunnybrook Health Sciences Centre gave Thunder Bay Regional's angioplasty program a rave review, declaring its outcomes comparable to or better than those of many full service centres.
The program has been beneficial for patients, as well as for the hospital, said Thompson.
"Before we started this program, patients who came in with a heart attack would frequently wait eight, nine or 10 days to be transferred by air ambulance to Ottawa or Hamilton. It was a huge expense. Now, they're being treated locally, recovering and going home a lot faster.
"And because they're receiving angioplasties a lot sooner, there's a lot less damage to their heart muscle, which means that in future we'll see fewer side effects related to heart failure and other dysfunctions associated with chronic heart muscle damage."
Hospital stays have also been reduced – from well over a week to three, four or five days, added Thompson.
One of the requirements for designation as a stand-alone angioplasty centre is the ability to transport a patient to a cardiac surgery centre within a 90-minute timeframe if complications arise. Thunder Bay's back-up cardiac centre is St. Luke's in Duluth, but of the 1,250 cases performed in Thunder Bay since 2007, there haven't been any failed angioplasties requiring a transfer for emergency surgery, and only four or five high-risk patients per year who are transferred out of the city for angioplasties at a hospital elsewhere in the province.
A final phase of Thunder Bay Regional's angioplasty program will focus on streamlining treatment and establishing protocols for heart attack patients from communities elsewhere in northwestern Ontario.
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