Program to Give Hospitals Practical Tools to Reduce Door-to-Balloon Times in STEMI to Begin

 

October 24, 2006

A new program designed to provide hospitals with practical tools to help them reduce door-to-balloon times in STEMI patients is in the works, and experts who have collaborated on the project say they hope to launch it next month. Spearheaded in part by investigators who have worked on previous Guidelines Applied in Practice (GAP) studies or on door-to-balloon-time research and in part by the American College of Cardiology (ACC), the D2B: An Alliance for Quality initiative is still being finalized but has already prompted calls from hospitals and physicians hoping to sign up.

According to Dr Harlan Krumholz (Yale University, New Haven, CT), one of the project innovators, the D2B campaign is an example of how health researchers are rethinking the translation of scientific findings into clinical practice.

"This is a great example of the old model vs the new model," he told heartwire. "In the old model, if you're an academic, you do a study, you publish it, and you figure people read it and act on it. But the real recognition in the past decade has been that there are really variable amounts of adoption of new information among the country's hospitals and that just publishing information likely won't do anything."

The D2B initiative draws on qualitative research done by Krumholz and others who have identified hospitals that were consistently treating patients within the guideline-recommended 90 minutes and have been interviewing staff at those hospitals to find out what factors were essential to trimming down the delay between the arrival of a STEMI patient at the emergency department and the reopening of the infarct vessel.

One example, Krumholz said, is having the emergency department (ED) physician activate the cath-lab team and to do this by making one call to a page operator, who then pages the entire cath-lab team, rather than having the ED doctor figure out who is on call and individually page each member of the team.

"Having the ED physicians activate the cath lab was a strong factor associated with faster times, but only 22% of the hospitals in the country had that factor in place," Krumholz explained. "It seems very straightforward, and some people might even ask why did you even have to study this, but it's because there are thousands of these different contributing factors, and when people are able to focus on what are the most important factors that need to be in place to reduce times, they can really make some rapid progress."

All of the D2B recommendations are reasonably straightforward but in some cases require a change in culture, not the least of which is more collaboration between the ED physicians and interventional cardiologists. Krumholz also emphasized that the initiative was not just for hospitals wanting to improve their times or "doing the basics" but for all hospitals. "The project is constructed to bring everyone together—to help the best get even better and those who are lagging to catch up. The effort focuses on an initial set of key strategies but also brings in much more to support the clinicians and the hospitals. We are seeking to sign up every hospital in the country that does primary PCI."

While the details of the D2B campaign are still being finalized, all of the ACC governors have already agreed to promote the D2B initiative within their individual states and encourage hospitals to get on board. Once the campaign is launched, the plan is to provide participating hospitals with a toolkit outlining the crucial factors to implement, as well as second-tier recommendations that may or may not be important in any given setting. The kit would also include information on how to best construct the team needed to implement the changes and be involved on an ongoing basis, what the roles and responsibilities of each team member should be, and how to identify the point person for the project within each institution.

"These are things that for some hospitals will be old hat, but other hospitals are saying, give it to me very clearly: what are the steps needed to get this done? We've tried to scale this down to the essentials, to make it very clear and easy, and to ultimately make this something that could be implemented anywhere," Krumholz said.

A web-based networking component will also allow successful hospitals to share tips, policies and procedures, and other documents with other hospitals. The project investigators then hope to survey hospitals after one year to find out whether the initiative is, in fact, resulting in reduced door-to-balloon times.

A wide range of different organizations and professional societies are also backing the project, including the American Heart Association, the Society for Cardiovascular Angiography and Intervention, the Joint Commission for the Accreditation of Healthcare Organizations, the National Heart, Lung, and Blood Institute, among others.

A spokesperson from the ACC press office told heartwire that the college has already received numerous calls from hospitals hoping to find out more about the initiative. For the time being, interested parties are going to have to wait until the D2B initiative is finalized and launched, possibly in November.