Posted December 7, 2006
Patient Safety and Quality Healthcare: News
The American College of Cardiology and Partners Launch National Alliance to Reduce Door-to-Balloon (D2B) Times
D2B alliance aims to save time and lives
Chicago, Nov. 13, 2006 — The American College of Cardiology (ACC), together with the American Heart Association (AHA) and other key national healthcare organizations, announces the launch of its latest quality campaign, "Door to Balloon (D2B): An Alliance for Quality." A Guidelines Applied in Practice (GAP) Program, the D2B campaign is aimed at improving the timeliness of lifesaving therapy for patients with heart attacks at the nation's hospitals that perform emergency angioplasty.
Door-to-balloon time refers to the interval between arrival at the hospital and the opening of a blocked artery with an angioplasty balloon. Patients who receive prompt treatment are more likely to survive a common type of heart attack called ST-elevation myocardial infarction (STEMI).
Previously published guidelines developed by the ACC and the AHA recommend that hospitals treating STEMI patients with percutaneous coronary intervention (PCI) should reliably achieve a door-to-balloon time of 90 minutes or less. However, accomplishing this level of performance is an organizational challenge and many patients are not treated within the guideline recommendation. Thus, improving timeliness of treatment represents an important opportunity to improve the quality of patient care.
"The D2B campaign provides a great way for the nation's hospitals to come together and make a promise to their patients that they will deliver rapid care and eliminate needless delays," says Harlan M. Krumholz, M.D., S.M., F.A.C.C., chair of the D2B Working Group. "In essence, by working together, we can make what is currently extraordinary performance, achieved by only a few hospitals, something that is routine and ordinary in clinical practice, ensuring that patients across the country with STEMI receive the proper treatment that they need."
Dr. Krumholz and a multidisciplinary team conducted a study funded by the National Heart, Lung and Blood Institute in which 365 hospitals were surveyed to identify strategies that were significantly associated with a faster door-to-balloon time. Data from this study will be simultaneously presented on Monday, November 13 at AHA's Annual Scientific Sessions in Chicago and published in the New England Journal of Medicine.
"The introduction of this new campaign is a giant stepİtoward increasing the quality of patient care forİheart attackİpatients," said Raymond Gibbons, M.D., F.A.C.C., president of the American Heart Association.İ "It will help these hospitals to deliver the best possible care to every patient."
Several evidence-based strategies have been identified to assist hospitals in reducing their door-to-balloon times. The strategies involve multiple departments and require a systems approach. They include:
- The emergency medicine physicians activate the catheterization laboratory (cath lab)
- A single call activates the cath lab
- The cath lab team arrives and is ready within 20-30 minutes
- Real-time data feedback in the emergency department and the cath lab
- Senior management commitment
- Team-based approach
Over the coming months, participating hospitals will receive an implementation manual and tool kit, as well as information on how to best construct the team needed to implement the changes; what the roles and responsibilities of each member should be; and how to identify the point person for the project within each primary PCI hospital.
An update on the campaign will be given at the ACC's Annual Meeting, ACC.07, in New Orleans from March 24-27, 2007.
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