Authors

• Željka Stojkov
• Blaženka Miškić
• Vesna Ćosić
• Barica Stanić
• Katica Cvitkušić Lukenda

Abstract

The development of the Coronary Care Unit (CCU) in Slavonski Brod started in 1960. Until then, patients diagnosed with stenocardia would be prescribed strict bed rest at the department over five to six weeks and would then be sent for further diagnostic processing to hospital centers in Zagreb in order to diagnose their existing coronary artery disease. Due to the efforts to improve quality of treatment and the development of diagnostic and treatment options, in the 1970s the CCU received a new space and staff that was specially educated for the treatment of coronary patients. During the Homeland War, the CCU was temporarily transferred to the north side of the Internal Medicine Department to protect it from the ravages of war. At the start of 2002, the construction of an addition to the old hospital building provided the Cardiology Department with a new CCU with seven hospital beds and equipped with central monitoring and the necessary medical devices for intensive treatment. The number of medical staff educated in administering intensive care was also increased. Treatment quality was also improved by the introduction of interventional cardiology that improved the quality of treatment and reduced morbidity and hospitalization. The opening of the arrhythmology unit completed the cycle of introducing all the interventional cardiology methods currently applied in the Republic of Croatia, especially in hospitals of this level of quality.

Keywords

diagnostics, myocardial infarction, coronary care unit

DOI

Full Text

The acquisition of the first electrocardiography (ECG) device in 1960 marked the start of the journey to create the Coronary Care Unit (CCU) in Slavonski Brod. The treatment of patient thus far when acute myocardial infarction (AMI) was suspected had consisted of several weeks (5-6) of bed rest. These patients were subsequently transported by ambulance to university hospitals in Zagreb for ECG and confirmation of the diagnosis of myocardial infarction ( 1 ). At the start of the 1970s monitoring of patients with possible stenocardia and rhythm disorders was performed using two monitors in the rooms of the Internal Medicine Department. The CCU was founded in 1975 as part of the Internal Medicine Department and was equipped with three monitors with ECG monitoring of heart frequency, pressure, and pulse that were used for patients with chest pains, AMI, and rhythm disorders. In the same year, the Internal Medicine Department moved to a newly-constructed building where the Coronary and Postcoronary Care Unit were formed. One physician and four nurses were then sent to the University Hospital Centre “Sestre milosrdnice” in Zagreb for education in monitoring and treating intensive coronary care patients. Due to the increasing need for treatment and growing number of patients suffering from coronary artery disease, an independent CCU was formed in 1979 with four patient beds and monitors for individual patient tracking. The first temporary pacemaker was implanted that year as well (by Dr B. Bucić). The acquisition of an echocardiography device, stress testing equipment, and a respirator was a step towards bringing the CCU closer to the standards of intensive treatment available in university hospitals at the time ( Figure 1 ). Until then, all diagnostic for heart disorders were performed in Zagreb, Ljubljana, or Belgrade. During the Homeland War, the CCU was moved to two rooms in the Gastroenterology Department in order to partially protect it from the ravages of war. It was equipped with four monitors. This kind of work required much greater and more strenuous engagement by its healthcare staff in providing the necessary care to coronary patients, but this never resulted in a reduction in the quality of care that was provided to the patients despite the meager conditions. The Coronary Care Unit in the 1990s. After the end of the Homeland War the unit moved to its old location and gradually acquired central monitors that facilitated hemodynamic monitoring for intensive care patients. The construction of an addition to the hospital building in 2002 increased the capacity of the Cardiology Department and the new CCU. The coronary unit got seven intensive care beds and two post-intensive care beds. The new space was also equipped with a new respirator, defibrillator, pulse oximeter, and all accompanying gear. In parallel with the acquisition of this new equipment, it also became possible to telemetrically monitor patients at the Cardiology Department. As the work now required more healthcare staff, systematization increased the number of nurses from four to nine, of which eight with nursing vocational school and one with a bachelor’s degree in nursing. Over time, some nurses were educated and completed a three-year college, receiving a bachelor’s degree in nursing. This resulted in a new organization of labor, and in 2007 the Intensive Coronary Care Unit employed five nurses with a bachelor’s degree and six nurses with nursing vocational school. The most significant development in cardiology at our hospital came in 2003 when the new Laboratory for Invasive Heart Catheterization was opened. The number of interventions grows every year, which requires more and more competencies and education for the staff working with these patients. After acquiring a large amount of experience in the field of invasive cardiology, we started with invasive interventions in 2003 and subsequently became part of the Croatian Network for Interventional Treatment of Acute Myocardial Infarction that covers the areas of Slavonski Brod, Nova Gradiška, Pakrac, Daruvar, Požega, and often also of Županja and Vinkovci. Initially the team employed an interventional cardiologist working with three other cardiologists, two nurses, and two radiology engineers. These numbers changed over time. After another hall for interventional cardiology was opened, we now have seven cardiologists, three nurses with a master’s degree, one with a bachelor’s degree, and one male nurse as well as two radiology engineers. Since treatment of sinus rhythm in angiography procedure halls was introduced there has been a growing need to increase the number of patients admitted to the CCU. Due to the great efforts and enthusiasm of all healthcare workers at the Intensive Coronary Care Unit, in no way is the treatment of patients brought into question and neither are our efforts to provide the necessary care at and after patient admission. At the start of 2019 we realized there was a need for a new telemetry system as malfunctions were common in the old one, and the acquisition of a new central system for monitoring patients at the department was made possible by a grant from the City Council. The acquisition of this equipment facilitates the work of the medical personnel and is beneficial to the patients as well, who are at high risk for the development of malignant arrhythmias. Today the Intensive Coronary Care Unit ( Figure 2 ) is equipped according to all the standards required for high-quality treatment of patients suffering from cardiovascular diseases. The unit space consists of: The coronary unit today. 7 patient beds 2 postintensive care beds 8 telemetry monitors 2 respirators 1 transportable respirator 2 defibrillators 2 ECGs 2 echocardiography devices The unit admits between 700 and 900 patients annually for intensive treatment ( Table 1 ). All the medical staff occasionally attends education programs in order to maintain the newest standards and recommended treatment algorithms in all segments of acute cardiological events. In addition to education through high-level university courses and completion of courses in advanced measures for reanimation and ECGs, all employees have also completed courses in communication skills in order to optimally ensure the psychological, emotional, and professional needs of the hospitalized patients.