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Bradley Finds Specific Strategic Plans Ensure Timely Emergency Care for Heart Attack Patients
Rapid emergency angioplasty is critical for patient survival; however only about 35% of hospitals regularly achieve our national goals for rapid treatment. In a new study published November 13 in the New England Journal of Medicine, Yale researchers identify 6 key strategies that the top performing hospitals use to expedite the care of patients with heart attacks. “If we can get all hospitals to implement these strategies, we can definitely improve heart attack care and save lives,” said Elizabeth H. Bradley, Ph.D., professor of public health at the Yale School of Public Health and lead author of the study. The timeliness of heart attack care in hospitals varies widely across the country, according to the authors. In this study, 365 hospitals nationwide were surveyed about how they treat heart attack patients. The researchers identified strategies that were correlated with "door-to-balloon" time-the time from when a patient enters hospital doors to the time blood flow is restored to the heart by opening a blockage with angioplasty. The faster patients are treated, the better their likelihood of survival. The study demonstrates how quality improvement techniques and key management efforts can improve clinical care. “Hospitals with top performance have often employed flow charting and data feedback techniques to identify bottlenecks and reduce delays. These are classic management skills in other industries and we can see they also can be effective to improve hospital care,” said Bradley. Key strategies included having emergency medicine physicians activate the catheterization laboratory, having a single call to a central page operator activate the laboratory, having the emergency department activate the catheterization laboratory while the patient is en route to the hospital, expecting staff to arrive in the catheterization laboratory within 20 minutes after being paged, having an attending cardiologist always on site and having staff in the emergency department and the catheterization laboratory use real-time data feedback about their performance. "Despite the effectiveness of these strategies, a minority of the hospitals surveyed were using them, even though many of the strategies were feasible and could be immediately implemented," said Harlan Krumholz, M.D., Harold H. Hines, Jr. Professor of Medicine and Epidemiology and Public Health at Yale and co-author of the study. "We know that reducing door-to-balloon time is important, but now we also have more evidence about how to achieve faster door-to-balloon times," Bradley said. "Having a good interventional cardiologist is not enough. How the hospital processes are organized and managed, and how teams work together within the hospital really matters to patient outcomes, especially in heart attack care, which requires coordination among many different staff members." The study coincides with the launch of the new "D2B" campaign by the American College of Cardiology, the American Heart Association and other partners, to improve door-to-balloon times by providing hospitals with practical tools to achieve this goal. The campaign, which will help educate hospitals on how to implement these six strategies, derives in large part from a four-year National Institutes of Health grant that helped to produce this study. "With this and previous studies, we have generated the knowledge that can help all hospitals provide timely care to their patients," said Krumolz. "With the D2B campaign to translate the science into action, we want to see what is currently considered outstanding care become standard and routine care. These strategies provide the roadmap for that to happen." Krumholz said most of the D2B recommendations are reasonably straightforward but in some cases require a change in culture, including increased collaboration between emergency department physicians and interventional cardiologists. "The project is designed for all hospitals-to help the best get even better and those who are lagging in door-to-balloon times to catch up," said Krumholz. "We are seeking to sign up every hospital in the country that offers emergency angioplasty for patients with heart attacks.” In addition to Bradley and Krumholz, the multidisciplinary team of authors on the NEJM article included Jeph Herrin, Yongfei Wang, Barbara Barton, Tashonna Webster, Jennifer Mattera, Sarah Roumanis, Jeptha Curtis, M.D., Brahmajee Nallamothu, M.D., David Magid, M.D., Robert McNamara, M.D., Janet Parkosewich and Jerod Loeb. The study was funded by the National Heart, Lung and Blood Institute and the Patrick and Catherine Weldon Donaghue Medical Research Foundation. Citation: New England Journal of Medicine, Early Online Edition; 2006. |
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