Reducing Door to Balloon Times

I recently attended a celebration for door-to-balloon time at Henry Ford Hospital.

It is a quality measure in the treatment of heart attacks, specifically an ST segment elevation myocardial infarction.

This particular form of heart attack has a high probability of destroying heart muscle, and leads to some of the direst of acute and chronic heart conditions.

Henry Ford Hospital Door to Balloon Team

The time interval measure starts when the patient arrives in the emergency department and ends when a cardiac catheterization wire, placed from the patient’s artery, crosses the blockage in the coronary artery.

This all sounds very technical, but it is easy to understand.

You are having a heart attack. The treatment is to quickly open the artery that is blocked. The technique used is by a heart catheter.

The longer it takes to open the artery, the more heart damage (“time is muscle”). And the more heart damage, the worse the patient does (“muscle is function”).

This measure is adopted as a core quality measure of how good a hospital performs in caring for heart patients.

The targeted time by expert guidelines is 90 minutes. A recent Michigan study shows only 70% of patients in the state receive care within this time frame.

Our hospital celebrated perfection for the last 13 months: Meeting this standard for all patients coming to our emergency department.

But our doctors and nurses aren’t satisfied with perfectly meeting a standard that is less than perfect.

They, along with many experts, are looking to reduce the time from the start of the heart attack (“I’m having chest pain”) to opening of the artery. This provides a more definitive, although harder to measure, start to finish of the process.

All of this is great, but it is not the story I want to tell. I want to tell you how a hospital gets these results.

As most of you who have watched any hospital TV drama know, there are an enormous number of individuals involved in caring for a heart attack patient – emergency responders, emergency department security guards, registration personnel, communications people, technicians, ER nurses, ER doctors, transporters, cardiologists and catheterization nurses.

You get the point. A lot of people, in a lot of departments, need to work together as a team to orchestrate in concert for one common cause.

Easy to say and understand, but very difficult to do. Just ask the Detroit Lions’ offensive line.

What it takes is a commitment to the goal of reducing door-to-balloon times by everyone involved, including senior management (someone like me), to make it a priority.

It takes measuring and repeat measuring of the times (you can’t improve what you don’t measure), understanding the workflow and processes to create the result (think LEAN production line), and a relentless commitment to meeting the goals.

But most importantly, it takes people from all areas that influence the process and the time to treatment working collaboratively – people willing to work together, despite their professional biases or concerns, and clinical leaders unwilling to compromise on meeting the goal.

I am so proud of this team, not only for their results, but also for their role as cultural change agents.

Not easy work, but great results. (Especially to a 61-year-old man with high cholesterol in a highly stressful job, who may not eat as well as he should and may not exercise as much as he should, who has an office two floors above the ER.)

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