The effect of simple interventions on paramedic aspirin administration rates

To determine the baseline rate of aspirin administration by paramedics and to assess the effect of two interventions (protocol change and brief educational intervention) on that rate.

The advanced life support transport provider's clinical database was retrospectively queried to identify calls involving adult patients with chest pain or paramedic impression of suspected cardiac event (possible acute coronary syndrome [ACS]). The study includes data from January 1, 1999, to June 30, 2002, which was divided into three distinct periods. Period 1 was the baseline, period 2 was after the protocol change intervention, and period 3 was after the brief educational intervention. The chest pain protocol indicates patients with chest pain should be treated with aspirin.

During period 1, 548 of 3,635 (15.1%) patients with possible ACS received aspirin. During period 2, 1,941 of 7,236 (26.8%) patients with possible ACS received aspirin (chi(2) p<0.0001; odds ratio [OR]=2.06; 95% confidence interval [CI]=1.86-2.29). During period 3, 749 of 2,026 (37%) patients with possible ACS received aspirin (chi(2) p<0.0001; OR=1.60; 95% CI=1.44-1.78). Comparing period 1 with period 3, after both interventions, there was a 22% absolute improvement in aspirin administration rates (chi(2) p<0.0001; OR=3.30; 95% CI=2.91-3.76).

Aspirin is underutilized in treating patients with suspected ACS. Two brief interventions can lead to modest increases in aspirin administration rates. Even after these interventions, aspirin administration rates remain low.