Cardiovascular Business - May/June 2008 - (Page 20)

PrOCess IMPrOveMent Most Challenging Problems Affecting Door-to-Balloon times 25– % of Hospital respondents 20– 15– 10– 5– 0– ED physician activation of cath lab Team-based approach Prompt data feedback Cath lab team available 20-30 minutes after page Single call activation of cath lab Other challenging problem Senior management commitment ED physician activation of the cath lab remains the single most challenging problem affecting door-to-balloon times, according to data from 522 hospitals and compiled by the D2B Alliance. ECG method that allows the EMS to diagnose a STEMI patient at first medical contact. If the pre-activated ECG is integrated with a downstream system of care, the paramedics can also be trained to activate the cath lab in the off-hours. Stressing the necessity of collaboration, Ting said that the major success of the initial door-to-balloon initiative lies in “breaking down the silos between the cardiologist and the ED physician. Joint accountability and partnership in a patient-centered process will produce the best model,” including extending that collaboration outside the hospital to the paramedic. “The latest data supports the effectiveness of this method, including a scientific statement from the American Heart Association to be published in the next six months indicating the amount of training required by EMS in order to implement a preactivation ECG,” Ting says. The University of Michigan Medical Center, which implemented a pre-hospital ECG program with its single EMS provider, boasted an average 82-minute door-to-balloon time in 2007 for both on- and off-hours, according to Nallamothu. The cath lab was activated 101 times for acute MI. “If a paramedic activates a pre-hospital ECG, the interventionalist is given a 20-minute head-start that the patient is coming,” Nallamothu said. Of course, different geographic locations throughout the U.S. can present varied challenges. Some rural areas do not have paramedics, and EMS personnel in these areas will need more in-depth training to interpret an ECG, while Los Angeles county has 7,000 paramedics for approximately 10 different EMS services, which can cause a lot of variability. Despite the geographic and financial implications, Ting still says that the pre-activation ECG method has a lot of potential because it simply organizes systems of care to deliver the best care. The Bottom Line While physicians from varying institutions have each implemented different methods to effectively reduce their off-hour door-to-balloon times, one question remains–can it be done inexpensively? The ACC is pushing toward the adoption of widespread prehospital ECG-activation. In fact, the most recently updated guidelines take into consideration first medical contact with EMS, instead of the traditional door-to-balloon timing. As a result, the first responders will be encouraged to become involved to develop systems to coordinate their care and develop strategies to transport the patient to facilities that can care for the patient most efficiently. This adoption would entail expensive up-front equipment costs to the hospitals. However, Aguirre says this system could be utilized by all first-responder care in the U.S., whether trauma, stroke or bioterrorism, so the benefits could be tremendous for patient care on a national level. Despite the potential national benefits of these systems, Memorial Medical was able to reduce its off-hour door-to-balloon times without incurring additional costs. And despite the strong movement within the cardiovascular community, Aguirre says he is unsure whether the adoption of pre-activation ECGs would reduce their off-hour door-to-balloon times any further, even though it may affect the on-hour times. The only other step Aguirre’s hospital could take to further reduce its off-hour times is to have a cath lab team on-site 24-hours, which is tremendously costly, he says. In the end, the shift toward adopting a pre-hospital ECG activation and a greater reliance upon first responders seems inevitable. While the initial costs may be burdensome, the STEMI patients continue to benefit, regardless of the time of day. 20 Cardiovascular Business May/June 2008

Table of Contents Feed for the Digital Edition of Cardiovascular Business - May/June 2008

Cardiovascular Business - May/June 2008 Contents First Word Cover Story - Coronary CTA: Drafting the Strategic Plan Financing New Technologies: Early Adopters, Lease vs. Purchase, and Joint Ventures Clinical Study Digest: ACE or ARB: It's Your Choice Can Off-Hour D2B Times Be Reduced Without Breaking the Bank? Digital Image Management Primer: Integrating Echo SPECT/CT for Cardiac Disease Detection: An Economic Conundrum Integrating the Healthcare Enterprise Connects IT Systems News & Views Calendar Reader's Resources The Back Page

Cardiovascular Business - May/June 2008

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