“No one had ever seen a cardiologist showing interest in ambulances or helicopters”
Time is of the essence when someone has a heart attack. Denmark has achieved great success by looking beyond the operating table to ensure patients receive the best care as fast as possible.
In the late 90s, it became clear that something had to be done about the way the Danish health-care system was dealing with patients with heart attacks. When looking at the quality of care, measured by the mortality rate 30 days after patients were admitted to hospital, Denmark lagged far behind the rest of Scandinavia.
Twenty years later, Denmark has lowered the 30 day mortality after admission for acute myocardial infarctions (heart attacks) to 7.7% and to 3.2% for large infarctions (STEMI), placing Denmark among the 3 countries with the lowest 30 day mortality rate according to Organisation for Economic Co-operation and Development (OECD) rankings.
“What we have done differently is to not only look at the way we were doing things within the walls of the hospital, but also at transport to the hospital, the diagnosis and a whole range of elements at society level,” explains Dr Jens Flensted Lassen, Clinical Director, Cardiac Catheterization Laboratory, the Heart Centre, Rigshospitalet, Denmark’s largest hospital.
Working within the hospital walls
In order to understand the extent of the problem, a large scientific project was initiated, looking at the best way to treat heart attack patients and how to ensure transport to a hospital that can treat them quickly and with the most information about their condition.
Using balloon angioplasty (percutaneous coronary intervention) instead of thrombolysis treatment in a few highly specialized hospitals was one of the answers. Another was to use helicopters to get patients there from outlying regions and to have the ambulances (and helicopters) start the diagnosis procedure with an electrocardiogram (ECG), sent directly to a specialist, while the patient is en route.
These were major changes to the country’s health-care system, and yet, according to Dr Lassen they were implemented quickly.
Breaking down silos and creating ownership
All cardiology departments in Denmark were part of the scientific project. The doctors and nurses around the country played their part, and when the results were published, they had a strong sense of ownership.
Other parts of the health-care system were also involved, as Dr Lassen explains: “Getting the patient onto the operating table is my job. The trip in the ambulance is someone else’s. But the whole process is a common responsibility, so one of our secrets is to break down the professional silos”.
Getting the attention of decision-makers
Denmark was first in the world to introduce ECGs in ambulances that could communicate directly with medical specialists in hospitals or on call. It was a huge breakthrough in getting patients the care they need as quick as possible. It meant that patients would arrive in the hands of a specialist who already knew that he or she was dealing with a heart attack and how to treat it.
But it took more than just medical research to get to that point. To convince decision-makers higher up to make the necessary investments, doctors had to learn how to speak another language – the language of politicians and civil servants.
Working with other areas such as the economy, traffic patterns, training of emergency medical technicians and helicopter specifications became important factors in determining how cardiologists could do their job.
“No one had ever seen a cardiologist showing interest in ambulances or helicopters before, but we reached a common understanding,” Dr Lassen recalls.
When looking back at the improvements in the treatment of heart attack victims, it is clear to him that one of the main reasons why patients are now getting much better care is the cross-sector cooperation that permeated the entire process. The success was made possible by the work across sectors, and is a great illustration of the crucial role that cross-sector partnerships have to play in achieving the Sustainable Development Goals, specifically by promoting multi- and intersectoral policies and action throughout the life-course.