Wednesday, June 24, 2015
D to S time
If, God forbid, you should have a heart attack, the chances
of your living or dying is determined more by door-to-stent (D to S) time than
by the relative competence of the physicians who treat you.
There are probably not many Americans who believe that, but
it is the clear implication of a long, front-page article that appeared in the
June 21 Sunday New York Times.
A heart attack happens when one or more arteries feeding blood
to the heart become blocked, denying the affected parts of the heart muscle the
oxygen they need to function and survive.
The remedy is to thread a tiny balloon to the blockage through a leg or
arm artery, open it up and maintain the opening with a metal-mesh tube called a
stent. If this now common procedure is
completed in a timely manner, the patient has a good chance of recovery. If not the patient either dies or is left
with a badly damaged heart.
According to the article, the death rate from coronary heart
disease dropped 38 per cent from 2003 to 2013.
Credit was given to better control of cholesterol and blood pressure,
reduced smoking rates, improved medical treatments, and faster care of people
in the throes of a heart attack.
The article then focused on the faster care factor. Some years ago, the American College of
Cardiologists set a goal of getting a stent planted in at least half of heart
attack patients within 90 minutes of arrival at the hospital (door-to-stent or D
to S time). In the beginning that was thought
unrealistic but now it is common for a hospital to achieve 61 minutes or less.
Several changes account for the bulk of the time
reduction. Rather than doing an EKG
after the patient arrives at the hospital, the Emergency Technicians do it in
the ambulance and send the results on ahead.
Rather than summoning the stent implant team members one at a time, a
single phone call simultaneously activates the beepers of all. On-call people are required to be no more
than 30 minutes away from the hospital. Consent
form requirements are waived. The
Emergency Room physician is allowed to summon the stent implant team directly
rather than being required to obtain confirmation of the diagnosis from a
cardiologist.
The article makes no mention of the credentials or
competence of the physicians.
