The authors said that effective collaboration between ambulance crews, emergency medicine staff and angioplasty teams could trim door-to-balloon times to 60 minutes or less.

"Not all hospitals may be able to replicate this idealized flowchart; but we believe that there will be useful and practical value for all hospitals," Dr. Krumholz said.

"This approach also helps us see what has worked in the real world, not just what might be designed as ideal interventions and implemented in a controlled study, so it gives us some faith that the efforts are feasible; not easy, but achievable," added lead author Elizabeth H. Bradley, Ph.D., also from the Yale University School of Medicine.

The researchers also had advice for patients who suspect they may be having a heart attack: call 9-1-1, instead of driving to a hospital.

"The value of activating 911 is not that an ambulance will drive faster than a family member taking you in the car, but rather that medical assessment and treatments can begin earlier, en route to the hospital," Dr. Bradley said.

Dr. Krumholz said the practices they identified do not necessarily cost more.

"Most of the innovations in the flowchart are about working smarter, not necessarily harder or with more staff. It is about proper organization and flow. It is about planning and preparing and communicating to everyone what is expected and when," Dr. Krumholz said.

"Real improvement in such a complex treatment process involves collaboration and coordination of many departments and disciplines, in ways more simple clinical processes may not require. This is bringing a systems mentality to medicine, whereby exceptional performance is not a property of individual
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Contact: Amy Murphy
amurphy@acc.org
301-581-3476
American College of Cardiology
28-Sep-2005