Collaborative Heart Attack Management Program

Timely access to care is always important, and especially so when every passing second adds to a patient’s risk of a negative outcome – as in the case of a heart attack. Sumandeep Dhesi, a cardiologist at Interior Health’s Royal Inland Hospital, recognized that precious time was lost by waiting until patients arrived at a hospital to administer life-saving medication (called thrombolysis). Inspired by a model used in Alberta and motivated by newly updated Canadian Cardiovascular Guidelines, Sumandeep and Interior Health cardiologists partnered with BC Emergency Health Services to pilot a program that would train advanced care paramedics to administer therapeutic clotbusting medication in the field. The Collaborative Heart Attack Management Program (CHAMP) was on a mission to save time and lives.

Including The Patient Voice

In the spring of 2019, the multidisciplinary CHAMP team invited PVN patient partner Don Grant to join its quality improvement work. Don, a longtime patient partner with personal experience of coronary artery disease, was keen to get involved. “I live a reasonable distance from the hospital, so without a drug and program like this…well, it’s really a game changer. Plus, I have always been drawn to lights and sirens,” he shared with a laugh. “It’s important to me that the voices of the people who will benefit are well heard.”

Don’s participation was not intended to influence the actual treatment protocol – that came from evidence and national guidelines. Rather, he helped ensure that efforts to implement the protocol prioritized patients’ needs, experiences and outcomes.

Anders Ganstal, a Regional Medical Director with BC Emergency Health Services, collaborated with Sumandeep on the CHAMP program and acknowledges the fundamental value of patient partner participation. “With any sort of project implementation, it is really important to ask the people that are using the program, and those who will be receiving the program, for their thoughts on how to best make the program work. If we are far removed from those people, then we are going to design a system that doesn’t include them and might miss a lot of important things,” he said.

Connection Before Content

Relationship building is key to success and Anders did this well. He spent time getting to know Don and ensured he was prepared by explaining the project and proposed partnership outside of formal project meetings where other agenda items can compete with the time and space needed for thorough conversation.

“I remember distinctly, I was walking in a park down in the village along the lake, and Dr. Ganstal called and told me about this program. I have been through a lot of these patient engagement projects, but seldom have I felt so included. Just spending 15-20 minutes telling me about the program to begin with I thought was pretty impressive,” shared Don.

Asking Questions Others Might Not

One of the first ways that Don participated in the project was by attending a training session for advanced care paramedics in Kamloops. He recalled asking a question that he was not sure would be of interest or help to the paramedics in the room, but then noticed others perking up to hear the answer.

“I did sense there was a bit of new understanding among the rest of the people in the audience,” he said. Indeed, patient partners often ask questions that others on a project team might not have considered or might not feel comfortable asking.

No Pandemic Pivots Required

Although the pandemic halted a lot last spring, the occurrence of heart attacks was not one of them. After launching in September 2019, the CHAMP pilot program continued through 2020 without substantial interference from COVID-19. In fact, patients who received the treatment in the field arrived at the hospital more stable than they might have been otherwise, which helped reduce the demand on critical care staff.

Outcomes & Impacts

As of Spring 2021, CHAMP had treated 21 patients in the Interior Health region. Impressively, the program demonstrated a 57% reduction in treatment time. Prior to the program, the median treatment time from symptom onset to thrombolysis was 94 minutes – now it’s down to 25 minutes. The project team is pleased and the patients who have been treated in the field are ecstatic! When interviewed by BC Emergency Health Services about the program, patients shared their gratitude as well as their interest in supporting its sustainability and expansion:

“I don’t think I would have made it without this treatment,”
“The paramedics were amazing,”
“If I see any of them now, I would like to hug and kiss them,”
“Anybody in my situation should be able to get this.”

The CHAMP team, BC Emergency Health Services and Interior Health are now working to spread the successful program across the region – and eventually to the rest of British Columbia.

Final Thoughts & Reflections

When asked what advice he might give to others embarking on a patient engagement partnership, Don compared patient engagement to the butterfly effect.

“Everything we do has some effect on something. [After collaborating], we all walk away with a different, improved, or maybe worsened view on a project. But everyone brings something, everyone can change something. We all have a unique perspective. Don’t treat [patient engagement] like a token [gesture]. ‘Tick the box – yes we’ve got a patient involved!’ Be open to criticism. Be open to a ‘dumb question’ – it theoretically could become a really important question.”

Anders recommends being open-minded and ready to receive criticism. “See patient engagement as an important tool to streamline your project and provide the best possible care. Back in the day, we used to see doctors saying, ‘I am the doctor, and this is what is best for you. I have the white coat, so listen to me, because I know what’s right for you!’ I am hopeful those days are almost completely gone. Putting the patient first, having the patient voice in decision-making in the health care system, is really important to know what’s really best for the patient.”

This story was featured in our 2020/21 Annual Report. Read more like it here.