Making progress
Sometimes we have to remember to stop and celebrate the accomplishments achieved in cardiovascular care. This week offers examples of better quality and value in healthcare.
First accolades go to a consortium of emergency medical service systems in Arizona who implemented a triage protocol for cardiac arrest patients that sent patients to the nearest cardiac receiving center rather than a local hospital. In a study published in Annals of Emergency Medicine, researchers reported improvements in survival and neurological outcome after the program was implemented.
On another front, interventional cardiologists who followed quality measures for using contrast media in patients undergoing PCI prevented contrast-induced acute kidney injury in one of five patients. The benefit was even more pronounced in patients with chronic kidney disease.
The protocols were not burdensome or costly. They involved oral hydration before and after PCI as well as patient education. Hospitals that initiated the intervention saw a 21 percent reduction in the rate of contrast-induced acute kidney injury. While the researchers did not calculate costs avoided through this approach, hospitals likely benefited—and certainly patients did.
Another study looking at time of presentation for STEMI patients offered more of a mixed bag, but ruffle through the findings and you see some positive trends. The researchers analyzed data submitted to the Acute Coronary Treatment and Intervention Outcomes Network-Get With The Guidelines (ACTION-GWTG) registry to determine if quality improvement initiatives that call for timely treatment had an impact.
Physicians treated almost two-thirds of the patients in the study during off-hours, which covered evenings, weekends and holidays. On several measures, care for off-hour and on-hour presentation was similar, including aspirin within 24 hours and median door-to-ECG times.
But off-hours patients had a median door-to-balloon time of 72 minutes vs. 56 minutes for on-hours patients and they were less likely to meet the 90-minute window. This group also had a higher adjusted all-cause in-hospital mortality rate. Given the gap between on-hours and off-hours care, there is room for improvement.
Nonetheless, compared with previous studies that looked at these trends, the times for the various steps in treatment protocols appear to be shortening. This is one of the many incremental achievements that result in better and more efficient care every day.
Candace Stuart
Cardiovascular Business, editor