Code STEMI Case Study

Teamwork Speeds Up Heart Attack Response Time

Cardiovascular disease is the leading cause of death in the United States, with heart disease a factor in 1 of 4 deaths, according to the Centers for Disease Control and Prevention.

Health care systems across the country are looking at ways to improve emergency cardiac care. Using its innovative lean management tools, ThedaCare, a community health system Northeast Wisconsin, has made significant changes and improvements when it comes to treating patients with a blocked major artery.


ThedaCare is a non-profit community health system based in Appleton, Wis., comprised of seven hospitals and 35 clinics in northeast Wisconsin. With nearly 6,100 employees, it is one of the largest local employers and dedicated to delivering world-class care for its patients. Since 2002, ThedaCare has embraced lean management principles as a way to improve the quality of care and while containing costs. The health system took the Toyota Production System model of lean manufacturing and adapted it for healthcare, creating teams of employees and patients to take a hard look at the way ThedaCare was doing things and come up with a better way.

In healthcare, a Code STEMI is called when one or more major arteries to the heart is blocked. This type of heart attack is treated by inserting a balloon catheter into the artery, clearing it. The longer the artery stays blocked, the more damage is done to the heart muscle. In the mid-2000s, the American College of Cardiology made a recommendation that patients should be taken to a cath lab, where the catheter is inserted, within 90 minutes of first contact, whether that’s a 911 call or a patient walking into the emergency department. Medical professionals call the window from first contact to when the catheter is inserted “door- to-balloon” time.

The Challenge: Getting patients quickly to the cath lab

With five hospitals – including three outside of the Fox Cities in rural Wisconsin – ThedaCare set out to improve the amount of time it took to get heart attack patients to the cath lab. To do this, ThedaCare created a team of physicians, employees, patients, and community partners, such as paramedics, to look at its Code STEMI process and find ways to improve it so patients could receive treatment more quickly.

“A Code STEMI event can be identified using an EKG, so we worked with our emergency department at Appleton Medical Center and other hospitals and area paramedics to come up with a protocol or plan that would help us get patients – and the necessary staff members – into the cath lab more quickly,” said Julie Ludwig, ThedaCare’s Code STEMI coordinator.

Since ThedaCare’s three rural hospitals do not have a cath lab, a plan was needed to help get patients from New London, Shawano, and Waupaca as quickly as possible to Appleton Medical Center’s cath lab.

The Solution: Communicate and educate

Every year, emergency room employees and paramedics see many patients suffering from having heart attacks. The key, Ludwig said, was developing and then implementing a plan of action when a patient is having a heart attack. The first step is to have an EKG done, which can immediately identify if a Code STEMI event is happening.

“If a Code STEMI is called, a whole protocol kicks in. Cath lab staff members – including the cardiologist – are called in to prepare for the patient and emergency department staff members will let the patient coming in on an ambulance bypass their department and take the patient right to the cath lab,” Ludwig said. “We took out steps that were being duplicated or unnecessary so we could reach our goal of getting the patient as quickly as possible to the cath lab.”

If the patient is in an emergency department at an outlying hospital, ThedaStar air medical is called to bring the patient as quickly as possible to Appleton Medical Center. ThedaCare also partnered with the paramedics serving those hospitals so they can call a Code STEMI in the field so ThedaStar can be called even before the patient arrives at the local hospital, saving precious time.

Communication and education about the new process and the importance of getting a patient to the cath lab as quickly as possible were shared with hospital staff members and paramedics so everyone was “on the same page” when a Code STEMI was called, Ludwig said.

The Results: Patients Get Treated More Quickly

Before Code STEMI was launched in 2005, the average time it took for Fox Cities patients to go from door-to-balloon was 91 minutes. For ThedaCare’s three outlying hospitals, that number was 212 minutes.

Using the Code STEMI protocol, the average door to balloon time for Fox Cities’ patients was 50 minutes in 2013. For patients at the outlying hospitals, the average time was 91 minutes.

What’s Next?

The Code STEMI team comes together bi-monthly using their lean management tools to look at how the program is working and if what possible changes and improvements are needed.

“It’s an ongoing process to make sure we are doing what we can to improve patient care,” Ludwig said. “We are always looking to continually improve.”