Achieving high quality in ST-segment elevation myocardial infarction care: one urban academic medical center
Yanina A Purim-Shem-Tov1, Normal Melgoza, Janet Haw
1Department of Emergency Medicine, Rush University Medical Center, Chicago, IL 60612, USA. Yanina-Purim-Shem-Tov@rush.edu
Insights
Improving ST-elevation myocardial infarction (STEMI) care is crucial. This study highlights achieving 100% compliance with door-to-balloon times under 90 minutes through a quality improvement program.
Area of Science:
- Cardiology
- Healthcare Quality Improvement
Background:
- Management of ST-elevation myocardial infarction (STEMI) presents challenges for academic institutions, particularly in urban settings with dispersed staff.
- Timely activation of catheterization teams and efficient electrocardiogram administration are critical for reducing delays in STEMI treatment.
Purpose of the Study:
- To describe the implementation and outcomes of a quality improvement program aimed at reducing door-to-balloon times in STEMI patients.
- To achieve and maintain adherence to the <90-minute door-to-balloon time benchmark.
Main Methods:
- Initiation of a quality improvement program for STEMI care in 1993, focusing initially on medication adherence (aspirin, beta-blockers, ACE inhibitors).
- Subsequent focus on optimizing door-to-balloon times as a key performance metric.
- Integration with the 'Get With The Guidelines' program to standardize care.
Main Results:
- Progressive improvement in the use of guideline-directed medical therapies from 1993 to 2003-2004.
- Achieved 100% compliance with door-to-balloon times of less than 90 minutes over the last two years of the study period.
Conclusions:
- Sustained quality improvement efforts are effective in optimizing STEMI care protocols.
- Achieving benchmark door-to-balloon times is feasible and critical for improving patient morbidity and mortality in STEMI management.
Abstract:
Management of acute myocardial infarction with ST elevation (STEMI) remains a challenge for academic institutions. There are numerous factors at play from the time electrocardiogram is obtained to the time the patient arrives to a catheterization laboratory and the balloon is inflated. Academic hospitals that are located in large urban centers have to deal with staff living long distances from the facility, and therefore, assembling the catheterization team after-hours and on the weekends becomes a difficult task to achieve. There are other factors that contribute to time delays, such as, administering electrocardiograms in timely fashion, having emergency physicians activate the catheterization team, instead of contacting the cardiologist to discuss the case, and other time-sensitive factors. All of the aforementioned issues contribute to the delay. Yet, primary percutaneous coronary intervention is clearly demonstrated as the modality of choice in treatment of STEMI, which improves patient's morbidity and mortality. Therefore, it is imperative that institutions do all they can to improve their protocols and meet the core measures in the treatment of STEMI patients, including the door-to-balloon time of less than 90 minutes. Our institution started a quality improvement program for STEMI care in 1993 and has showed progressive improvement in use of aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, and other medication, culminating in 95% to 100% use of these medications in 2003-2004, when we operated in accordance with the Get With The Guidelines program. Door-to-balloon time in less than 90 minutes became a new phase in our quality improvement process, and we achieved 100% compliance in the last 2 years.
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