Best Practices Project Improves ER Heart Attack Success
Lauran Neergaard, AP
Hospitals are giving faster care to lots more heart attack patients, which translates to more lives being saved. Better than three-quarters of people suffering major heart attacks are getting their blocked arteries reopened within 90 minutes of arriving in the emergency room, says a Yale University study of 831 hospitals.
In 2005, half of patients were getting treated that fast, says a recent study in the Journal of the American College of Cardiology. Cardiac guidelines have long warned that delaying even half an hour longer increases the risk of death.
An ambitious project has been introduced to reduce what doctors call “door to balloon time,” or the time from hospital arrival to getting an angioplasty or similar procedure. Hundreds of hospitals — about 70 percent of those able to perform emergency angioplasties — signed up to share speedy strategies.
By spring of 2008, 76 percent of patients who qualified for that kind of care received it in time. More recent data shows continued improvement. Nearly 82 percent of eligible patients had a 90-minute or less door-to-balloon time in those hospitals by last summer. Hospitals not participating in the campaign didn't improve door-to-balloon times as quickly, the study found.
Study co-author Dr. Harlan Krumholz, a Yale cardiologist, said alerting slower hospitals to the problem allowed them to copy faster competitors. The changes that helped most were simple steps that cut a few minutes here and there. One such step was letting the emergency room activate the catheter lab upon the patient's arrival, or even after a call from the ambulance on its way, instead of waiting for a cardiologist to confirm the diagnosis before getting ready for angioplasty. Some hospitals assigned cardiac catheter teams to be on duty 24 hours a day. Others required that on-call doctors arrive within minutes of a page from the ER.
“Nobody got paid an extra dollar for it,” Krumholz said of the campaign. “Nobody was being penalized if they didn't do it. This was people saying it's the right thing to do for patients.”