NBGH a leading Ontario hospital for treating heart attack

A study conducted by the Institute for Clinical Evaluative Sciences shows that the North Bay General Hospital is a leader in providing the fastest heart attack treatment once a patient is admitted to the Emergency Room.

The General’s “door to needle” time for treatment of heart attack victims was 27 minutes, the study stated, 10 minutes faster than the overall average time of 37 minutes in other provincial hospitals.

Entitled Enhanced Feedback for Effective Cardiac Treatment (EFFECT), the report, released last month, assessed cardiac care in Ontario Hospitals.

It also set Canada’s first benchmarks for care for patients suffering heart attacks and heart failure.

Right in the ER
The study randomized the 85 participating hospital corporations into two groups that would receive either early or delayed feedback on key clinical performance indicators.

North Bay General Hospital’s results were compared in the early group of hospitals receiving feedback, while the delayed group will receive its feedback this fall.

Emergency Room physician Dr. Ralph Del’Aquilla said one of the reasons NBGH patients receive their treatment faster than the provincial average is that ER staff are trained to administer the necessary drugs right in the ER.

“If we didn’t do that in the ER, we would have to transfer the patient to intensive care where a specialist would administer the drug, all of which takes added, critical time," Dr. Del’Aquilla said.

Cardiac risk factors
The ICES study recommended that the provincial average ‘door to needle’ time should be 30 minutes in treating heart attack victims.

It also recommended that hospitals should work towards training emergency room physicians to administer the necessary medications in the ER to bring their ‘door to needle’ times in line with this recommendation.

Nancy Jacko, vice-president, Medicine Care Centre and Mental Health and Addictions for the General, said the study also broke down the hospital’s patient cardiac risk factors and showed that 31 per cent of patients treated smoke, 50 per cent suffer from hypertension, 33 per cent have increased fat in their blood streams and 28 per cent have diabetes.

”Eighty-three percent of these patients had more than one risk factor. The average age of patients treated in this study at North Bay General was 68, with 41 per cent of patients being female,” Jacko said.

Clinical benchmarks established
The EFFECT study builds on a decade of cardiovascular research at ICES and includes a number of firsts:

— First randomized study in the world to assess whether developing and publishing report cards based on clinical data collected from patient charts leads to greater use of evidence-based therapy at hospitals that receive them;

— First time that clinical benchmarks have been established for heart attacks and heart failure care in hospitals in Canada;

— First time that Canadian heart attack and heart failure indicators based on high quality clinical data has been available in Ontario on a population-wide basis;

— First major review of heart attack and heart failure care in Ontario since the ICES Cardiovascular Atlas of 1999;

— First time that a study of this size has been undertaken in Canada.

Good level of care
Several trends were found in this study too.

Most cardiac patients, for example, have a modifiable cardiac risk factor (i.e. a lifestyle factor that can change—smoking, obesity).

Generally, the study also concludes, a very good level of care is being provided for heart attack and heart failure patients in Ontario hospitals, but there is room for improvement.

Many Emergency Departments have organized themselves to provide fast delivery of life saving thrombolytic therapy, the study found.

Hospitals performing below benchmark on ‘door to needle’ time could improve their performance by training and allowing all Emergency Room physicians to administer thrombolytics, rather than having the drug administered once the patient is transferred to the critical care unit or intensive care unit.

Patient outcomes can be improved by ensuring that all patients are discharged from hospitals on the necessary medications.