Specific strategic plans ensure timely emergency care for heart attack patients

Hospitals that provide the most rapid emergency angioplasty have specific strategies to expedite the care of patients with heart attacks, researchers at Yale School of Medicine report in the November 13 New England Journal of Medicine.

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 found that among the hospitals sampled, the range of door-to-balloon times was between 55 and 120 minutes. The national guideline for door-to-balloon time is 90 minutes or less. Many hospitals do not achieve these national guidelines for even most of their patients. However, some hospitals do better than others and six strategies were associated with significantly faster door-to-balloon times.

These 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 for staff 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 lead author Elizabeth Br

Contact: Karen N. Peart
Yale University

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