Israeli Hospitals Ramp Up Response Times for Life-saving Surgeries, Data Shows

Major improvements have been made in response times to heart attacks, strokes and hip fractures

A hospital in Israel.
Moti Milrod

Hospitals significantly improved their performance of several critical procedures last year, according to an annual Health Ministry report.

The report, which has measured various performance indicators for the last five years, will be published later this month. Haaretz has obtained the data on five of the most important indicators, including response times to heart attacks and strokes and operations to repair hip fractures.

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Heart attacks are the second-biggest cause of death in Israel (after cancer), and some 4,000 urgent catheterizations are performed every year to save patients. Medical literature shows that death rates drop significantly if catheterization is performed within 90 minutes of a patient’s arrival.

When the ministry began measuring performance indicators in 2013, only 68 percent of catheterizations were performed within this time frame. Last year the number was recorded at 91 percent. Ichilov in Tel Aviv was reported as having the fast time-frame, followed by Bnei Zion in Haifa and Assaf Harofeh in Tzrifin. in Netanya, Meir in Kfar Sava and Sheba in Tel Hashomer were reported as having the slowest response times.

Strokes are Israel’s fourth-biggest cause of death and leading cause of disability. Best professional practice calls for an MRI or CT to be performed within 25 minutes of the patient’s arrival to determine whether the problem is internal bleeding or a blood clot, and for a diagnosis to be made within 45 minutes.

In 2015, when the ministry first added this indicator, the average wait for an MRI or CT was 55 minutes, and in some hospitals, it was 90 minutes or more. But last year, the average fell to 33 minutes. The best performing hospitals, by which all MRIs and CTs were performed under 25 minutes, were Hadassah Ein Karem in Jerusalem, Western Galilee in Nahariya and Ziv in Safed. The worst were Yoseftal in Eilat, Haemek in Afula and Wolfson in Holon.

A transient ischemic attack (TIA), is a minor stroke, but those who have one are left at greater risk of a having a major stroke in the near future. The ministry recommends that a Doppler ultrasound of the carotid artery be performed within 72 hours of the patient’s arrival to monitor his blood flow.

In 2015, when the ministry introduced this indicator, only 58 percent of these tests were performed within this time. But last year, the rate rose to 78 percent. The best performers (90 percent or more) were Hadassah Ein Karem in Jerusalem, Rambam in Haifa and Western Galilee. The worst were Bnei Brak’s Mayanei Hayeshua, Holon’s Wolfson and Beilinson in Petah Tikva.

For people who have a major stroke, a tissue plasminogen activator (TPA), and brain catheterization can prove beneficial. Both increase blood flow to the affected region and thereby reduce brain damage. A TPA should be done within four and a half hours of the first signs of stroke and a brain catheterization within eight hours.

Last year, 1,393 patients received appropriate treatment within the proper time frame, up from 857 in 2015.

Hip fractures are common among the elderly, and while they not only substantially reduce quality of life, they often lead to further health complications. An operation within 48 hours of a patient’s arrival can significantly improve outcomes – though there are cases where operating isn’t the preferred treatment. The ministry’s target was for 85 percent of patients to be operated on within the 48 hours time frame.

In 2013, only 71 percent of patients underwent a timely operation. But in 2017, the rate rose to 86 percent. The hospitals closest to the ministry’s target were Haifa’s Rambam, Soroka in Be’er Sheva, Hillel Yaffeh in Hadera and Holon’s Wolfson. The lowest rates were at Netanya’s Laniado and Afula’s Haemek, and three hospitals had rates in the high nineties – Kaplan in Rehovot, Nazareth’s Scottish Hospital and Kfar Sava’s Meir.