Care Pathway Effect on In-Hospital Care for ST-Elevation Myocardial Infarction

Area of Science:

• Cardiology
• Healthcare Management
• Quality Improvement

Background:

• ST-elevation myocardial infarction (STEMI) requires timely intervention for optimal patient outcomes.
• Standardized care pathways can improve the efficiency and effectiveness of STEMI treatment.
• Evaluating the impact of care pathways on both reperfusion and secondary prevention is crucial.

Purpose of the Study:

• To assess the impact of a care pathway on timely coronary reperfusion for STEMI patients.
• To evaluate the effect of the care pathway on secondary prevention strategies in STEMI patients.
• To analyze composite outcomes related to STEMI care following pathway implementation.

Main Methods:

• Implementation of a care pathway using the Collaborative Model for Achieving Breakthrough Improvement.
• Conducted pre-intervention and two post-intervention audits of adult STEMI patients eligible for reperfusion.
• Utilized multilevel logistic regression to analyze adjusted differences in composite outcomes, controlling for hospital, transfer, and admission timing.

Main Results:

• Significant improvements observed in the intervals from first medical contact (FMC) to percutaneous coronary intervention (PCI) and door-to-PCI between post-intervention audits.
• Secondary prevention initially deteriorated post-intervention but showed significant improvement between audits.
• Transfer patients and those admitted during out-of-office hours experienced poorer outcomes and longer FMC-to-PCI intervals.

Conclusions:

• Care pathway implementation led to improved composite outcomes for in-hospital STEMI care.
• Collaborative initiatives effectively addressed performance variations among hospitals.
• Iterative and incremental implementation of the care pathway maximized performance enhancements.