Cardiovascular Business - October/November 2007 - (Page 14) OutCOmes › by lisa frat t Strategies to Trim Door-to-Balloon Time Door-to-balloon time (D2B) is a critical cardiac quality indicator. As a whole, U.S. hospitals are doing fairly well with other quality indicators, says Betsy Bradley, PhD, professor of public health at Yale University in New Haven, Conn., but D2B time is a challenge for many sites. Here are some prescriptions to break the 90-minute barrier. completed within the ‘golden hour’ tend to have better outcomes with improved cardiac pumping function and less scarring. That’s because achieving optimal door-to-balloon time is a complex undertaking that requires a high degree of collaboration among multiple disciplines, reorganized processes and constant vigilance. Nevertheless, hospitals are making progress. More than 900 hospitals enrolled in the American College of Cardiology’s (ACC) D2B: An Alliance for College in the six months since the organization’s inception. About half, such as Saint Mary’s Hospital, a Mayo Clinic hospital in Rochester, Minn., Carolinas Medical Center-NorthEast in Concord, N.C., and Alegent Health hospitals in Omaha, Neb., already meet the 90-minute mark and provide models for their colleagues. “[Door-to-balloon] strategies are simple and inexpensive. Improvements don’t require a new CT scanner, new drugs, smarter physicians or faster helicopters,” asserts Henry Ting, MD, vice chair division of cardiovascular disease at Mayo Clinic. In fact, it’s possible to produce hefty improvements in door-to-balloon time with minimal investment. The end result, however, is quite powerful as sites that minimize door-to-balloon time can point to improved patient outcomes and care. This month, Cardiovascular Business details what it takes to meet the 90-minute goal. Individual site prescriptions vary, but there are common denominators among hospitals that meet the mark. These include: → Prompt EKG studies → Streamlined activation of the cath lab by the ED physician → Ongoing and consistent data and process reviews → Multidisciplinary teamwork A 14 Cardiovascular Business merican College of Cardiology guidelines put the door-to-angioplasty time at 90 minutes for optimal therapy. No more than 90 minutes should pass between the time a STEMI (ST elevation myocardial infarction) patient arrives at the hospital to the angioplasty. There is a high correlation between door-to-balloon time and patient survival, but only 30 to 40 percent of U.S. hospitals meet the guideline, says Bradley. Patients whose angioplasty and stents are Inside a D2B pioneer “There are very few things I can do as a cardiologist in 30 minutes that can have a tangible impact on patient survival, but October/November 2007
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