The Success of the D2B Program and Beyond

Innovation in medical practice is key. In order to develop and improve practice, physicians, administrators and other cardiovascular team members must remain in constant scrutiny of current methods, always searching for ways to improve the overall quality of cardiovascular care.

An example of innovation as a result of scrutiny can be seen in ACC's Door to Balloon (D2B) program. D2B was initiated in 2006 to cut the time between a patient in need of immediate cardiovascular care entering the hospital and receiving catheterization. The initiative was based on research by the Yale University team headed by Harlan M. Krumholz, MD, SM, FACC. Since its establishment, the program has become common practice for the treatment of cardiovascular care in hospitals across the nation.

Initiating Nationwide Change

In order to organize a nationwide campaign of any kind, it is critical to break the mission down into smaller pieces. This concept rings especially true in the medical field. Sweeping change in medical methodology cannot be made solely at the national level. In the case of D2B, grassroots campaigning was a necessity to the program's success.

John E. Brush Jr., MD, FACC, past ACC Governor of Virginia, has had ample experience rallying the troops to embrace new methods. According to Brush, the ACC played an integral role in assisting with the establishment and promotion of the nationwide D2B campaign, nothing that the structure of state chapters helped facilitate the widespread dissemination of the message.

"Grassroots campaigning was huge for D2B in Virginia," says Brush. "In addition to constant leadership and encouragement from colleagues like C. Michael Valentine, MD, FACC, Peter K. O'Brien, MD, FACC, and others, people picking up the phones and making contact – that's what made the program take off. Other states followed the same protocol, and soon it became a competition to see which state would be first to get all of their hospitals involved."

Engaging Competitive Nature

Brush was especially keen on one specific motivational tactic encouraged by D2B – competition. Engaging the competitive tendencies of doctors is generally a productive way to encourage improvement within hospital practices. According to Brush, this sort of competitive spirit should continue to be harnessed to sharpen skills and improve the overall quality of care.

"Interventional cardiology is almost an athletic sport. The time sensitivity of cardiovascular care in some ways mimics the time sensitivity of athletics, so it fits naturally to tap into the competitive spirit. If you can find a way to work off of that type of competitive spirit, it develops a positive energy for that project," he explains.

However, there are no awards or medals for the competition within D2B. Rather, the satisfaction comes from noted improvement in survival rates and the reduction of patients' wait times.

The College's NCDR defines data and enables hospitals to collect it, which provides enormous opportunity to motivate physicians and hospitals to improve. "Everyone wants to be above average," says Brush. "If everyone is trying to beat the average, the average improves."

He explains that physicians and other members of the cardiovascular care team have developed an institutional skillset enabling them to meet the time goals when taking care of patients. "Engaging in the competitive tendencies of these team members creates an environment where these skills can further be sharpened," he adds.

Moving Forward

When asked how D2B could improve further innovation in cardiovascular care, Brush explains that the amazing thing about D2B is that the improvements have persisted. "They have continued even as the intensity of the campaign has faded. We have fixed the D2B problem, and our next step is to look for other challenges," he says.

In terms of future programs similar to D2B in structure, Brush believes that all of medicine can benefit by looking for ways to cut out wasted time, and seeking to complete necessary tasks in parallel rather than in a series. "Stroke care is certainly an area where the cutting out of wasted time is beneficial," he continues, "Sepsis is another excellent example outside of the cardiology field. The earlier antibiotics and supportive measures are administered, the better the patient's chance of survival."

Brush also remarks that, when considering future advancements in cardiovascular care, prevention and primary care cardiology must be prioritized. Improving the diagnosis and treatment of hypertension and ensuring that economic disparities don't get in the way of distributing care are also of the utmost importance.

"The ACC has the ability to reach out through their communication channels and leadership to help people realize the ‘next big challenge,'" says Brush. "This ability to draw attention is going to have a huge impact."

Similarly to D2B, many of these issues can be addressed by analyzing and comparing the data from hospitals across the nation and pinpointing best practices.

According to Brush, "The keys to improving any kind of care are measurement and feedback. One must have measurements and feedback from credible information sources. This is where our current resources come into play."

By fully utilizing current data resources, such as the NCDR, the hope is to continue to scrutinize current practices, and zero in on areas in need of improvement. Going forward, hospitals and physicians can improve the use of current resources by more efficiently utilizing the given data. "Finding efficiencies, breaking down deficiencies and improving them – this is what the D2B project was," explains Brush. "Strategies improved by looking at the hospitals that were doing it best."

This method of constant critique and improvement will continue to lead to development in the quality of health care. By imitating the successful project style of D2B and applying that style to new health care challenges, the cardiovascular care community will continue to improve the lives of patients.

Clinical Topics: Prevention, Hypertension

Keywords: Anti-Bacterial Agents, Hospitals, Hypertension, Primary Health Care, Sepsis, Stroke, Survival Rate, Cardiology Magazine, ACC Publications

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