Having recently blogged an attempt at change that failed utterly, here's one that worked. I guess we should figure out some of the differences between the two, but that carries the danger that we will draw conclusions from an n=2 comparison - not very rigorous! We should really look to a systematic review of change initiatives.
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Ok, so now I've issued the caution I'm going to plunge in. It seems to me (Evidence hierarchy class 5 - expert opinion) that one key to success is persuading everyone that It Matters. Time matters. Minutes matter. I was at a meeting yesterday on pancreas transplant. In solid organ transplant it matters whether the ischaemic time (the time between removing the organ from the donor and putting it into the recipient) is 10 hours or 12 hours. You have to work to make everyone in the hospital know that Time Matters - the people who allocate theatre time need to know, the other surgeons competing for theatre time need to know, the anaesthetists freeing up beds on ITU need to know etc etc.
I travel a lot by train and there is no doubt (Evidence class 5 - weary traveller) that things have improved a lot in the UK compared to five years ago. That's partly because every platform in every station now has a large digital clock which shows seconds as well as minutes because seconds matter. We didn't realise that before, but now we do. (Of course they've done other stuff too like doors you can't open, barriers which shut as depature time nears etc - the environmental structuring which is necessary to change people's behaviour.)
Back to door to needle time. There has been a substantial improvement in the %age of patients treated in under 60 minutes, and an improvement in in-hospital survival.
If you are thinking like a true public health person, you may be saying to yourself 'Door to needle is all very well, but what about the bit before you even reach the door?' They've thought about that too, at least in Berlin - why not give tPA in the ambulance?
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