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RACE: a statewide model of better, faster heart attack care
Date:11/4/2007

CE project was based on a trauma system. It involved caregivers at 65 hospitals and associated emergency medical teams throughout North Carolina. Participants were divided into five regions Greenville, Durham, Winston-Salem, Charlotte and Asheville. Everyone focused on a single goal to provide the fastest, most beneficial care to the greatest number of heart attack patients eligible for reperfusion, or artery-opening therapy. Reperfusion therapies include clot-dissolving drugs and blood thinners as well as a surgical procedure called angioplasty that uses slender catheters carrying balloons and stents to prop open blocked vessels.

Physicians in the RACE program credit the decision to move care forward with much of the programs success. Moving care forward means enabling first responders to do as much of the work as possible. To that end, paramedics were trained to do the work of emergency room physicians and emergency room physicians were trained to do the work of cardiologists. A single phone call from the field was enough to bring an angioplasty team to the catheterization lab, and hospitals had to admit heart attack patients, even if they didnt have any beds. Cardiologists had to give up some of the control we were used to having, says Jollis. It was a hard habit to break. But once we saw the results, we knew we could trust the process.

Over the two years of the program, physicians collected information on 2,000 patients, measuring pre and post-intervention times for key processes: the time from when the patient arrives at the hospital door to either angioplasty or clot-busting therapy, and the time it takes for a patient at a feeder hospital to enter and leave the transferring hospital, and the time a patient enters a feeder hospital to treatment at a second, receiving hospital. Times improved substantially in all areas.

  • Median time from door to treatment for hospitals offering angioplasty fell from 85 to 74 minutes. (22 pe
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Contact: Michelle Gailiun
michelle.gailiun@duke.edu
919-724-5343
Duke University Medical Center
Source:Eurekalert

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