Improving the non-ST-segment elevation acute coronary syndrome (NSTEACS) pathway using quality improvement...

Area of Science:

• Cardiology
• Healthcare Quality Improvement
• Health Services Research

Background:

• The National Institute for Health and Care Excellence (NICE) recommends coronary angiography within 72 hours for high-risk acute coronary syndrome patients.
• Compliance with this guideline is crucial for timely cardiovascular event management.
• Variability in care pathways can delay critical interventions.

Purpose of the Study:

• To improve adherence to the 72-hour NICE quality standard for the non-ST-segment elevation acute coronary syndrome (NSTEACS) pathway.
• To reduce the time from hospital admission to coronary angiography by 50% between a district general hospital and its cardiac tertiary centre.

Main Methods:

• Prospective data collection on NSTEACS pathway duration.
• Utilized process mapping, ease-benefit matrix, Pareto analysis, and Plan-Do-Study-Act (PDSA) cycles for quality improvement.
• Involved front-line staff from both the district general hospital and the tertiary centre.

Main Results:

• Four PDSA cycles were completed between January 2021 and March 2023.
• The average time from admission to angiography decreased from 172 to 94.72 hours (a 45% improvement).
• Process changes were sustained in the district general hospital, but not in the tertiary centre due to staffing constraints.

Conclusions:

• Quality improvement initiatives, including PDSA cycles, can significantly reduce NSTEACS pathway duration.
• Sustaining process changes requires addressing systemic issues like staffing in tertiary centres.
• Optimizing the NSTEACS pathway enhances adherence to NICE guidelines and improves patient outcomes.