International Circulation: You talked about a change in time from 120 minutes down to 56 minutes. How much of that relates to processes occurring in parallel or just learning to work faster?
　　《国际循环》：您谈到从120分钟到56分钟的变化。这种改变有多少是与此并行过程相关，有多少只是工作过程的加快呢？
　　Dr Kugelmass: Very little of it was learning to work faster. I think when people always try to work faster， the reality is this makes you work slower. Part of it is processes in parallel. Part of it is setting very clear expectations: how long it should take a patient to get an EKG and make a diagnosis; how long it should take from getting an EKG and calling somebody who then will come in. I talk a lot about trust. You have doctors being woken up at home at 2am in the morning and being asked to drive through a snow storm to come to the hospital based on a different doctor or an ambulance driver’s interpretation of making a diagnosis. The cardiologist doesn’t decide to come in; the ambulance driver or the emergency room doctor decides that they need to come in. That is revolutionary.
　　Kugelmass：只有极少部分是工作过程的加快。我认为每当人们试图加快工作速度时，反而会使之减慢，用时减少的部分原因是在上述并行进程的加速，这来源于非常明确的预期设置：多久应获取患者心电图并做出诊断；多久应完成患者心电图并调用然后通知急救。这与信任相关，专科医生凌晨2点在家被唤醒，根据不同的医生或医院的救护车司机的解释作出诊断，不管狂风暴雪来到医院。不是心脏科医师自己而是救护车司机、急诊室医生决定他们必须到场，这是革命性的流程。
　　International Circulation: When did that happen?
　　《国际循环》：这种变革是什么时候发生的呢？
　　Dr Kugelmass: That happened five or six years ago and that was the key step. Mandating that people live within a certain distance and time from the hospital or stay at the hospital is another key step. It is not that they pushed the patient down the hallway faster; it was that the barriers to doing this efficiently were broken down.
　　Kugelmass：这关键的一步发生在五六年前，强制医生居住在与医院一定的距离的地方或留宿医院，这是另一个关键的一步。这并没有使运送患者更加迅速，而只是将阻挡消除。
　　International Circulation: A lot of that is organizational. A lot of it is technological of course.
　　《国际循环》：部分原因是组织性，部分当然也有技术原因。
　　Dr Kugelmass: Getting the EKG in the ambulance and being able to send it to a Smartphone is technological. That’s about two years old. But even before they were sending it to the Smartphone， they were still making the decision in the field.
　　Kugelmass：在救护车上获取心电图并发送到智能手机上，这项技术已经开展了两年左右。在心电图发送之前，急诊救护人员仍需自行作出判断。
　　International Circulation: They would make the decision themselves and then call?
　　《国际循环》：他们会自己作出的决定，然后决定通知专科医生？
　　Dr Kugelmass: That or they had the capacity to telefax it in， which wasn’t as efficient. Really it is changing the way we do things through organizational management.
　　Kugelmass：或者他们有能力先传真心电图，但这样效率不高。组织管理确实改变了我们做事的效率。
　　International Circulation: Door-to-balloon time is a great statistic but how accurate do you think it is? How strongly related is it to the final outcome of revascularization?
　　《国际循环》：急诊室到首次球囊扩张时间是一个伟大的的统计，但您认为它的准确性如何呢？它与血运重建的最终结果相关性如何？
　　Dr Kugelmass: There is good data to show that the shorter the door-to-balloon time， the better the survival rate， the better the ejection fraction， the better the preservation of myocardium. The next step is symptom-to-balloon time. If you have somebody at home waiting two hours before they call is our next challenge. We talk about continuous quality improvement; there is always something to improve upon.
　　Kugelmass：有良好的数据显示，时间越短预示着更好的生存率、更好的射血分数，更好的心肌保护。我们下一步挑战则是从症状开始到球囊扩张时间，减少那些在家等待了两个小时才打电话急救的患者。我们不断谈论提高服务质量，并进行改善。
　　International Circulation: Do you have any ideas on how to approach something like that?
　　《国际循环》：您就如何处理这样的事情有什么建议吗？
　　Dr Kugelmass: That’s a public health education campaign.
　　Kugelmass：我认为这需要通过公众的健康教育活动，提高人们对疾病的认识。

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