NCPA - National Center for Policy Analysis


November 13, 2006

Hundreds of hospitals around the country are joining the most ambitious project ever undertaken to give faster emergency room care to people suffering major heart attacks.

  • Fewer than one-third of heart attack patients now get their blocked arteries reopened within 90 minutes of arrival, as guidelines recommend.
  • The risk of dying goes up 42 percent if care is delayed even half an hour longer.

One of the problems is that the preferred remedy for doctors -- angioplasty -- can be very time consuming.  Guidelines call for a "door-to-balloon" time of 90 minutes, but according to Dr. Elizabeth Nabel, director of the Blood Institute we haven't engineered our emergency rooms to cut out some of the steps that aren't needed and cause delays.

But as part of the project, Yale University researchers Elizabeth Bradley and Dr. Harlan Krumholz surveyed 365 hospitals and found six measures that consistently helped save time:

  • Letting ER doctors activate the catheterization lab and prepare it for angioplasty instead of waiting for a cardiologist to review a case and decide what to.
  • Establishing a one-call system so a central operator pages an angioplasty team instead of having ER staff hunt down phone numbers and individual doctors on call.
  • Having the ER activate the cath lab when paramedics alert them that an electrocardiogram done in the ambulance shows the patient is suffering a heart attack.
  • Expecting staff to be at the cath lab within 20 minutes of being paged.
  • Having a cardiologist on site at all times.
  • Giving immediate feedback to the staff on how they did on each.

About 1,250 of the 5,000 hospitals in the United States have been invited to join the campaign to implement these procedures and dozens of hospitals in Europe and North and South America also have expressed interest.

Source: Marilynn Marchione, "Hospitals Want Faster Heart Attack Care," Forbes, November 13, 2006.


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