Department Specializing in Cardiology

Mission

At all times, the Emergency Department provides individual consultations for urgent cardiac problems. It also provides the quality care and services required to treat the patient's condition, with a client focus.

Main Objectives

• To ensure that each patient receives the highest quality emergency care by offering access to the most recent diagnostic and therapeutic approaches in cardiac emergencies
• To contribute to the development of new evaluation and treatment methods
• To become a leader in the area of cardiac emergencies, first at the regional level, then nationally and eventually internationally
• To become a training center for the evaluation of cardiac emergencies for emergency physicians and nurses
• To ensure and support research development in the field of cardiac emergencies
• To ensure a full medico-nursing ED co-administration

Team

• 9 EP
• 34 nurses
• 10 orderlies
• 4 clerks
• 1 liaison nurse
• 1 medical secretary
• Consultants in cardiology and various disciplines

Secretary
Lise DeRepentigny
(514) 376 3330 extension 2092

Strategic Development 2001-2006

The ED has been located at its current site since 1987. The first EPs were recruited in 2000, and the team was completed in 2004. In 2003, it was the subject of a major physical restoration and significant organizational change. It is one of the seven services in the Institute's medical department. Perfectly integrated with the hospital, it contributes to more than 70% of the admissions.

The ED is co-managed by the head nurse and the medical director. This makes it possible to develop a common development vision, to efficiently deal with various issues at hand and to choose the best strategies to increase global performance. Its model is often cited as an example.

The development of the MHI's ED has been, without a doubt, unequalled in Quebec over the last years. It underwent a complete overhaul of its physical organization, human resources, information management, internal and external networking, vision, academic activity, research and publications. In the spring of 2000, the ED service had adopted a strategic plan (2001-2006) integrated with the MHI plan. Three main objectives were defined:

• To completely renew the physical organization of the ED
• To support the development of an academic unit, including teaching, research and development activities
• To create a tangible link with Urgences-Santé

Physical Organization and Transformation

Following the funding decision made by the MHI Foundation and the Regional Agency, in-depth restoration of the ED was carried out in the summer of 2003.

This allowed the ED to significantly increase its capacity (a total of 33 stretchers, including the shock room and 4 other stretchers), relocate the shock room towards the front of the building, move the triage towards the reception, enlarge the work station, create an isolation room and reorganize various utilities to make them more functional.

The project benefited from excellent preparation on the part of management, which made it possible to maximize the different skills of the ED employees and managers. Thanks to the commitment of everyone involved, the project was completed within the allotted time frame and the results exceeded all expectations.

The MHI ED is also in the process of becoming an academic service, ensuring teaching, research and development from the perspectives of EP and ED RN

Research

The ED plays a major role in research at the MHI and takes part in a multitude of international multicentric research projects. The majority of these projects gave rise to publications, many of which have lead to significant changes in the approach to cardiac emergencies.

Various other projects are currently under way. We also received four research grants last year, as well as financing from the pharmaceutical sector.

One major project concerns the impact of pharmacists on ED patients. The study was designed in collaboration with the faculty of pharmacy at the University of Montreal and involved more than 400 random patients in February 2005. It also has derivative projects involving two Master's students.

Publications et congrès

To this day, ED members have published several works. In addition, Dr. A Vadeboncoeur, head of the medical department, and Mrs. Danielle Perreault, head nurse, will take part in organizing the first Interdisciplinary International Convention on Emergencies that will take place in Montreal June 26-30, 2005.

Links with ED-Health

Along with EP François de Champlain and Urgences-Santé , Dr. Alain Vadeboncoeur co-directs a research project about the validation and implementation of the 12-lead ECG in EMS [?]. 200 Eastern Montreal technicians completed this training in June 2003. In parallel, work with other researchers includes the deployment of an emergency cardiology network for ST+ MI: RAPID-IM. The Réseau québécois de cardiologie tertiaire has demonstrated interest in this work, which was also presented at the Montreal cardiology RUIS.

External Links

In order for the ED to function correctly, there must be close cooperation among all departments of the MHI, diagnostic and therapeutic services, as well as counselling and support services. It can only function smoothly if all network components are involved. For this purpose, the ED has developed links with its external environment, such as:

• The Urgences-Santé Corporation (Montreal-Laval EMS)
• Surrounding hospitals
• CLSC
• Surrounding medical offices
• University of Montreal

Patients and Care

Since the ED is representative of the MHI's clinical activities, we find patients there who are affected by all diseases of the cardiovascular system. The role of the MHI ED largely exceeds the intervention field of a conventional ED, and 90% of its patients are cardiac. The main diagnoses are as follows:

• Ischaemic cardiopathies and angina
• Arrhythmias
• Cardiac insufficiency
• Valvular diseases
• Diseases of the pericardium
• Disorders of cardiac conduction
• Cerebral vascular diseases
• Chronic cardiopathies
• Diseases of the circulatory apparatus
• Post surgical status: bypasses, valvular replacement, cardiac transplants, etc.

At the MHI, ED patients show specific characteristics that have influenced the development of unique ED practices. Therefore ED patients are primarily those with cardiac problems and ensuing complications.

ED and the Institute demonstrate specific features that have given way to rarely-seen ER processes.  Access to specialized investigation resources (nuclear medicine, cardiac echographic transoephageal, stress tests, specialized consultants, anaesthesia) has therefore become much easier.

At the MHI, the ED actually includes a chest pain unit, which is also responsible for treating arrhythmias and cardiac insufficiency.

The general flow of patients is as follows:

ED investigations are very thorough and efficient, allowing for advanced patient stratification.

A regular increase in the number of patients over the last 10 years–about 4% per year–lessened in 2002-2003 (by a few dozen patients), was stable in 2003-2004, and increased slightly in 2004-2005. The percentage of stretcher patients remained stable, at 51%, as the following graph shows:

The MHI Admission and Hospitalization Committee worked out a Decongestion Plan that was implemented in January 2004. The plan describes 4 levels of hospital congestion and the actions to be taken by all MHI departments for each level. Since then, the situation has greatly improved.

Conclusion

The cardiologic patient will always be our focus, at the heart of our mission. We strive to reach the highest quality standards of care and we will continue to work very hard to achieve this goal.