EFFECT OF CONTINUOUS QUALITY IMPROVEMENT METHODS ON REDUCING TRIAGE TO THROMBOLYTIC INTERVAL FOR ACUTE MYOCARDIAL-INFARCTION

被引:24
作者
KRALL, SP
REESE, CL
DONAHUE, L
机构
[1] Department of Emergency Medicine Medical Center of Delaware, Wilmington, Delaware
关键词
THROMBOLYTIC THERAPY; MYOCARDIAL INFARCTION; QUALITY ASSURANCE; HEALTH CARE; EMERGENCY DEPARTMENT;
D O I
10.1111/j.1553-2712.1995.tb03597.x
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objectives: To assess the timeliness of thrombolytic therapy in the ED for selected patients with acute myocardial infarction (AMI) following continuous quality improvement (CQI) interventions. Methods: A retrospective, historical comparison study was performed of triage-to-thrombolytic time intervals for AMI patients using chart review for data collection. Patients treated after implementation of the CQI process vs a historical control group were compared. The patients with AMI who had received thrombolytics during the one-year period prior to the CQI interventions and who had documentation of time intervals served as the control group. The patients treated during a four-month period, beginning about one and a half years following introduction of the CQI interventions, served as the intervention group. Interventions included: a triage protocol, CQI review, and staff feedback. Results: The mean triage-to-thrombolytic interval was longer for the control group (72 +/- 25 vs 40.0 +/- 22 min; p < 0.0001). The mean triage-to-ECG interval also was longer for the control group (16.5 +/- 8.9 vs 8.5 +/- 7.5 min; p < 0.0001). Most (79%) of the study group received thrombolytic therapy within 60 minutes, and 39% within 30 minutes, whereas 39% of the control group received thrombolytic therapy within 60 minutes, and 3% within 30 minutes. Conclusion: The implementation of CQI techniques, including 100% chart review, intensive systems analysis, and staff feedback, had a positive effect on the timeliness of thrombolytic therapy for the ED patients who had AMI. As a result, most (79%) of the patients received therapy within the 60-minute time window recommended currently by the American Heart Association.
引用
收藏
页码:603 / 609
页数:7
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