House Bill 1790, sponsored by Rep. Robert Wayne Cooper, creates a "Time Critical Diagnosis System" for stroke and ST-elevation myocardial infarction (STEMI), a particularly fatal type of heart attack. Missouri is the first state in the nation to enact legislation governing a STEMI and stroke statewide system of care.Well, since this is D2B time is now a tracked "Pay-for-Performance" measure, I guess it's not surprising that we're circling our wagons and spending countless hours to fufill the government's expectations. But the data upon all of this wild excitement rests is based on "hospital door" to "balloon" time, not "patient's door" to "balloon" time. Doctors still need time to assess the complexities of social situations and confounding medical issues. Should a patient with widely disseminated cancer who also has an acute heart attack recieve similar "life-saving" resources? Further, one wonders how much more administrative and bureaucratic overhead our healthcare system can handle for this one initiative. What about the patients already in the ER waiting to be seen? It goes without saying that the administrative complexities of this system are sure to be stunning. Just look at all of the bureaucratic planning:
The health department has already been preparing the state to implement a system of stroke and STEMI centers. A Time Critical Diagnosis Task Force that was formed by the department in November has been meeting to discuss how to build the new system. The task force included more than 100 members of the emergency medicine community.The first question to be answered by the Task Force should be this: when have 100 people in a committee ever fully agreed on anything?