A case map reduces time to administration of thrombolytic therapy in patients experiencing an acute myocardial...

As one of the first hospitals in northwest Arkansas to begin administering thrombolytic therapy to patients with heart attack, or acute myocardial infarction (AMI), Crawford Memorial Hospital (CMH) first administered streptokinase to a patient experiencing an AMI on April 26, 1984. A national standard in lytic therapy was set in 1992 by the National Heart Attack Alert Program Coordinating Committee. The committee set a benchmark of having every appropriate AMI patient receive thrombolytic therapy within 30 minutes of hospital arrival. To monitor quality in lytic therapy administration, CMH began to participate in the National Registry for Myocardial Infarction (NRMI), in January 1995. The first quarter of data revealed a median door-to-drug time (time from arrival at hospital to administration of drug) of 67 minutes. As a quality improvement project, a research experiment was conducted to assess the effect of a case map, also referred to as a clinical pathway, on time to administration of thrombolytic therapy. A case map is a written management plan that provides the ideal sequence and timing of health care staff actions to achieve optimal patient outcomes with minimal variation in care. The researcher developed a case map designed to increase efficiency in delivery of thrombolytic agents. The research was conducted throughout an 18-month period from July 1995 until December 1996. Median time to administration of thrombolytic therapy was reduced from 64 minutes to 25 minutes as a result of case map use (p = 0.028). In this article, research findings are presented regarding the use of case maps in thrombolytic therapy, as well as implications for practice.