ERs get advice for treatment

Two Yale researchers have come up with a set of recommendations for hospitals treating heart-attack patients that say could potentially save thousands of lives.

Yale Epidemiology and Public Health professors Elizabeth Bradley GRD ’96 and Harlan Krumholz ’80 have found that certain procedural steps can consistently reduce the elapsed time between the moment when heart attack victims enter the emergency room and the moment when they begin to receive angioplasty, a procedure in which a balloon is inserted into a patient’s clogged artery in order to restore blood flow. According to the American College of Cardiology and the American Heart Association, the time between these two events, referred to as Door to Balloon Time (DBT), should ideally be no longer than 90 minutes for patients to have the best chance of survival.

Ambulances wait outside Yale-New Haven Hospital, where newly developed strategies for treatment of heart attacks could save lives.
Matt Lucas
Ambulances wait outside Yale-New Haven Hospital, where newly developed strategies for treatment of heart attacks could save lives.

Krumholz said one of the major motivations behind the research was to provide better health care in hospitals and reduce DBT by introducing inexpensive strategies that most hospitals can implement. These methods would ideally help eliminate time wasted in transporting the patient from the emergency room to the catheterization lab where angioplasty takes place, he said.

“They are relatively straightforward and inexpensive strategies that would ensure that [hospitals] can better care for their patients,” he said.

The recommendations include instituting a one-call system for an entire angioplasty team instead of looking for individual doctors, which can save about 13.8 minutes. In addition, researchers found that having a cardiologist on-site at all times can save approximately 14.6 minutes.

Though the research was only recently made public, Krumholz said Yale-New Haven Hospital has been using some of the suggested strategies for two to three years. These changes have reduced DBT dramatically at Yale-New Haven, he said.

Bradley said DBT is a good performance measure for hospitals because heart attack patients should be transported from the emergency room to the catheterization lab as soon as possible. She said she found that over half of the hospitals studied did not begin the angioplasty within the ideal time frame.

“About 65 percent of hospitals could not meet the guidelines,” she said. “If this is so important for the patient’s survival, why aren’t hospitals meeting those guidelines?”

Bradley and Krumholz said that studying hospitals with high DBTs allowed them to assess how best to save time. From the 365 hospitals they surveyed, the researchers developed six key procedural steps to be implemented in hospitals that did not meet the standards. With the help of these steps, Bradley said, it is possible for hospitals to meet the guidelines and reduce their DBTs to the recommended under-90 minute time frame.

Gail D’Onofrio, a professor of emergency medicine at the medical school, said the research underscores the need for hospitals to step up their care by using procedures that have been proven effective. She also said she thinks this research will give lagging hospitals a boost.

“I think what they’re trying to highlight is that we know this procedure works,” D’Onofrio said. “People will go to hospitals [meeting the guidelines], and maybe other hospitals will change their policies. They need to be willing to invest their money and personnel to provide this service.”

The researchers are planning to launch a national campaign targeting hospitals to publicize their findings and emphasize the importance of meeting the DBT guidelines.

“I estimate that if we can have hospitals adopt [the changes], we can probably save thousands of lives,” Krumholz said.

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