Guidelines are all the rage these days. For good reason.
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While these “guidelines” are indeed an improvement in getting patients to the angiography suite, realize that less than half of these patients’ D2B time was less than the 90-minute “goal” proposed by the ACC.
Although I posted a piece earlier that was a bit tongue-in-cheek regarding these efforts, with the drop in angioplasty rates, one wonders…
Most hospitals do not own three helicopters (Mayo’s authors claimed that because they already had these assets, they added little extra cost) and the implementation of these far-reaching efforts would be exceptionally costly for most other hospital systems to implement.
Just because industrial engineering practices apply to certain components of medical practice, like emergency managment of a heart attack) doesn’t mean that it works as a general principle in medicine. For one thing, the goal is fairly concrete and objective and uniform. That is often not the case. In many areas of medical practice, the goal of therapy must first be worked out as it will be highly variable from patient to patient.
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