Multicentre analysis of current ST-elevation myocardial infarction acute care pathways
Joppe Tra1, Carolien de Blok2, Ineke van der Wulp1
1Department of Occupational and Public Health, EMGO+/VU University Medical Center, Amsterdam, The Netherlands.
Open Heart
|September 12, 2017
Summary
Dutch percutaneous coronary intervention (PCI) centers vary in ST segment elevation myocardial infarction (STEMI) care processes, impacting guideline adherence. Sharing best practices can improve timely reperfusion for STEMI patients.
Area of Science:
- Cardiology
- Healthcare Management
- Process Improvement
Background:
- Timely reperfusion via percutaneous coronary intervention (PCI) is critical for ST-segment elevation myocardial infarction (STEMI) patients.
- Guideline-recommended treatment times for STEMI are frequently exceeded in clinical practice.
- Understanding variations in care processes is essential for optimizing STEMI treatment.
Purpose of the Study:
- To compare Dutch PCI centers' processes against European guidelines for STEMI care.
- To identify factors that accelerate the STEMI treatment pathway.
- To analyze how centers balance speed and diagnostic accuracy in STEMI management.
Main Methods:
- A multiple case study design involving 28 interviews with STEMI care providers across six PCI centers.
- Within-case and between-case analyses of transcribed interview data to describe care processes.
- Qualitative coding (open and axial) to identify perceived accelerating factors.
Main Results:
- Significant variations exist in PCI center processes, including patient routing, monitoring, ECG transmission, and catheterization lab preparation.
- Centers demonstrated different strategies for balancing treatment speed with diagnostic accuracy.
- Perceived accelerating factors included trust in preliminary diagnoses and reduced inter-provider consultations.
Conclusions:
- Substantial process differences among Dutch PCI centers impact adherence to STEMI treatment time targets.
- Various time-saving strategies are employed, but their configurations differ.
- Sharing best practices between centers and countries is recommended to enhance STEMI patient care.
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