Monday, November 13, 2006

Cultural Paralysis as a Cause of Death

About a third of the 865,000 heart attacks in the U.S. are caused by blockage of a major artery that supplies oxygen to the heart. According to current guidelines, those patients should have angioplasty within 90 minutes of arriving in the hospital Emergency Room. If treatment is delayed a half hour longer, the risk of death goes up by 42%.

At present, less than one-third of all such patients receive angioplasty within the recommended 90 minutes.

According to the November 13, 2006 issue of The Boston Globe, The American Heart Association is launching a program to improve this situation and “hundreds” of hospitals are expected to participate.

The Globe article also reported a Yale University study which analyzed the time saved by certain steps that have been implemented in various hospitals. The results are as follows:

· Letting the ER order the cath lab to get ready rather than waiting for a cardiologist (8.2 minutes)
· Have a one-call system that summons the angioplasty team rather than have an ER clerk call everyone individually (13.8 minutes)
· Let the ER doc order the cath lab to get ready when paramedics report that an EKG taken in the ambulance indicates a heart attack (15.4 minutes)
· Require members of the angioplasty team to show up within 20 minutes of being paged (19.3 minutes)
· Keep a cardiologist on site 24/7 (14.6 minutes)

These are all things that any hospital could do without waiting for a national association to launch a program.

Since lives are at stake, one wonders why they don’t do it. The only reason I can think of is that it remains culturally unacceptable for the management of the institution to become that involved in clinical matters and the professional staff is insufficiently disciplined.

In other words, you could die from cultural paralysis.

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