Effect of audit on door-to-inflation times in primary angioplasty/stenting for acute myocardial infarction

Ward, Michael R.; Lo, S.; Herity, Niall A.; Lee, David P.; Yeung, Alan C.

doi:10.1016/s0002-9149(00)01370-9

Cited by 30 publications

(20 citation statements)

References 9 publications

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“…Quality assurance, realtime feedback, and healthcare provider education can also reduce the time to therapy in STEMI. 89,[93][94][95][96][97] Involvement of hospital leadership in the process and commitment to support rapid access to STEMI reperfusion therapy are critical factors associated with successful programs.…”

Section: Systems Of Carementioning

confidence: 99%

Part 10: Acute Coronary Syndromes

O’Connor¹,

Brady²,

Brooks³

et al. 2010

Circulation

240

167

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Section: Systems Of Carementioning

confidence: 99%

Part 10: Acute Coronary Syndromes

O’Connor¹,

Brady²,

Brooks³

et al. 2010

Circulation

240

167

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“…Other studies found similar associations for specific conditions. Critical pathways for AMI reduced door-to-drug time with thrombolytic therapy, 31,32 decreased door-to-balloon times for angioplasty, 33,34 and increased beta-blocker usage. 8,35 Pathway use was associated with increased use of angiotensin-converting enzyme inhibitors in HF patients, 36 and improved oxygen assessment and timely antibiotic administration in pneumonia patients.…”

Section: Discussionmentioning

confidence: 99%

Relationship Between Organizational Factors and Performance Among Pay-for-Performance Hospitals

et al. 2009

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Services (CMS)/Premier Hospital Quality Incentive Demonstration (HQID) project aims to improve clinical performance through a pay-for-performance program. We conducted this study to identify the key organizational factors associated with higher performance.METHODS: An investigator-blinded, structured telephone survey of eligible hospitals' (N=92) quality improvement (QI) leaders was conducted among HQID hospitals in the top 2 or bottom 2 deciles submitting performance measure data from October 2004 to September 2005. The survey covered topics such as QI interventions, data feedback, physician leadership, support for QI efforts, and organizational culture. RESULTS:More top performing hospitals used clinical pathways for the treatment of AMI (49% vs. 15%, p< 0.01), HF (44% vs. 18%, p<0.01), PN (38% vs. 13%, p< 0.01) and THR/TKR (56% vs. 23%, p<0.01); organized into multidisciplinary teams to manage patients with AMI (93% vs. 77%, p<0.05) and HF (93% vs. 69%, p< 0.01); used order sets for the treatment of THR/TKR (91% vs. 64%, p<0.01); and implemented computerized physician order entry in the hospital (24.4% vs. 7.9%, p<0.05). Finally, more top performers reported having adequate human resources for QI projects (p<0.01); support of the nursing staff to increase adherence to quality indicators (p < 0.01); and an organizational culture that supported coordination of care (p<0.01), pace of change (p<0.01), willingness to try new projects (p <0.01), and a focus on identifying system errors rather than blaming individuals (p<0.05).CONCLUSIONS: Organizational structure, support, and culture are associated with high performance among hospitals participating in a pay-for-performance demonstration project. Multiple organizational factors remain important in optimizing clinical care.KEY WORDS: organizational factors; organizational culture; hospital performance measurement.

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“…Four studies demonstrated a positive impact of feedback on reducing the door-to-balloon interval (10 to 54 minutes) (LOE 3 667,671 ; LOE 5 679,680 ). These studies were heterogeneous and had significant limitations.…”

Section: Real-time Data Feedbackmentioning

confidence: 99%

Part 9: Acute Coronary Syndromes

Bossaert

O’Connor²,

Arntz³

et al. 2010

Circulation

103

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These experts reviewed 25 topics related to the acute initial management of acute coronary syndrome (ACS), which was further categorized as unstable angina, non-ST-elevation MI (UA/NSTEMI) and ST-elevation MI (STEMI). Topics were identified based on previous recommendations, emerging science, and clinical importance, using an iterative writing process involving all Task Force members. The Task Force reviewed the evidence specifically related to diagnosis and treatment of ACS in the out-ofhospital setting and the first hours of care in the in-hospital setting, typically in the emergency department (ED). The evidence review took place over several years, with ongoing refinement of recommendations being made as new evidence was published. The purpose of the review was to generate current, evidence-based treatment recommendations for healthcare providers who serve as the initial point of contact for patients with signs and symptoms suggestive of ACS.The following is a summary of the most important changes in recommendations for diagnosis and treatment of ACS since the last ILCOR review in 2005. 1,2• The history and physical examination, initial ECG, and initial serum biomarkers, even when used in combination, cannot be used to reliably exclude ACS in the prehospital and ED settings.• In contrast, chest pain observation protocols are useful in identifying patients with suspected ACS and patients who require admission or may be referred for provocative testing for coronary artery disease (CAD) to identify reversible ischemia. Such strategies also reduce cost by reducing unnecessary hospital admissions and improve patient safety through more accurate identification of NSTEMI and STEMI.• The acquisition of a prehospital 12-lead ECG is essential for identification of STEMI patients before hospital arrival and should be used in conjunction with pre-arrival hospital notification and concurrent activation of the catheter laboratory.• Nonphysicians can be trained to independently interpret 12-lead ECGs for the purpose of identifying patients with STEMI, provided that appropriate and reliable STEMI criteria are used. This skill is of particular value in the prehospital setting where paramedics may independently identify STEMI, thus mitigating over-reliance on ECG transmission.• Computer-assisted ECG interpretation can be used to increase diagnostic accuracy of STEMI diagnosis when used alone or in combination with ECG interpretation by a trained healthcare provider.• STEMI systems of care can be implemented to improve the time to treatment. The following measures have been shown to reduce the time to primary percutaneous coronary intervention (PPCI): institutional commitment, use of a team-based approach, arranging single-call activation of the catheterization laboratory by the emergency physician or prehospital provider, requiring the catheterization laboratory to be ready in 20 minutes, having an experienced cardiologist always available, and providing real-time data feedback.• Intravenous (IV) ␤-blockers should not be give...

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Effect of audit on door-to-inflation times in primary angioplasty/stenting for acute myocardial infarction

Cited by 30 publications

References 9 publications

Part 10: Acute Coronary Syndromes

Part 10: Acute Coronary Syndromes

Relationship Between Organizational Factors and Performance Among Pay-for-Performance Hospitals

Part 9: Acute Coronary Syndromes

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