Effect of Continuous Quality Improvement Analysis on the Delivery of Primary Percutaneous Transluminal Coronary Angioplasty for Acute Myocardial Infarction

Ho, Kalon K.L.; Stoler, Robert C.; Sukin, Craig A; López, John J.; Cohen, David J.; Kuntz, Richard E.; Berman, Aaron D.; Carrozza, Joseph P.; Baim, Donald S.

doi:10.1016/s0002-9149(97)00074-x

Cited by 80 publications

(48 citation statements)

References 14 publications

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“…It is noteworthy that when entered into critical pathways, patients had a 49% greater chance of receiving fibrinolytic therapy within the National Heart Attack Alert Program goal of 30 min after hospital arrival, 5 and a 66% greater chance of receiving primary angioplasty within the recommendation of 90 min after hospital arrival. 6 These findings are similar to those previously obtained in U.S. hospitals by Cannon et al 3 and by Caputo et al, 7 thus indicating that establishment of a critical pathway for ST-elevation MI also allows European EDs to improve quality of care by decreasing time to treatment.…”

Section: Discussionsupporting

confidence: 83%

Critical pathways in the emergency department improve treatment modalities for patients with ST‐elevation myocardial infarction in a European hospital

Pelliccia¹,

Cartoni²,

Verde³

et al. 2004

Clinical Cardiology

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SummaryBackground: The use of protocols for patients with ST-elevation myocardial infarction (MI) is growing, but no definite conclusion regarding the value of critical pathways in Europe has been drawn.Hypothesis: The aim of this study was to investigate the impact of critical pathway on processes of care and outcome for patients presenting to the emergency department (ED) of a large urban European hospital because of possible ST-elevation MI.Methods: Critical pathways for management of acute chest pain at our ED were developed in 1998 and have been revised every year. Accordingly, the records of all patients referred in 1997 to the ED because of chest pain (before pathway implementation) and in 2001 (after last pathway revision) were reviewed. An ST-elevation MI was diagnosed at ED in 520 of 5,066 (10.3%) patients with chest pain in 1997, and in 452 of 4,843 (9.3%) patients with chest pain in 2001. Patients were managed according to the ED cardiologists' decisions in 1997, whereas they entered the pathways for ST-elevation MI in 2001, with predefined criteria for diagnosis, thrombolysis, percutaneous coronary intervention, and admission to the coronary care unit.Results: Comparison of treatment modalities disclosed that more patients were given thrombolysis in 1997 (49 vs. 16%,

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Section: Discussionsupporting

confidence: 83%

Critical pathways in the emergency department improve treatment modalities for patients with ST‐elevation myocardial infarction in a European hospital

Pelliccia¹,

Cartoni²,

Verde³

et al. 2004

Clinical Cardiology

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“…21 In another study using optical coherence tomography repeatedly accessed radial arteries showed more intimal tear & thickening, medial dissection, and thrombi. 22 These pathological and physiological changes may ultimately lead to RAO. In our study among 69 patients only one (1.45%) elderly lady had RAO at third month follow-up which is pretty infrequent than in some studies (up to 18%).…”

Section: Discussionmentioning

confidence: 99%

Radial Artery Patency after Trans-radial Cardiac Catheterization in a Bangladeshi Population

et al. 2015

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Background: Transradial cardiac catheterization (TCC) is now preferred method over trans-femoral approach globally including Bangladesh. But the incidence of radial artery occlusion (RAO) after TCC is not infrequent and it ranges from 1-18% in different studies. The aim of our study was to see the incidence of RAO after TCC in a population coming for coronary angiogram and/or coronary intervention and also to evaluate the factors responsible for RAO. Methods: The observational prospective study was performed in all consecutive patients coming for TCC. Pre and three month post-procedural modified Allens test, reverse Barbeau test & Duplex ultrasonography for radial artery diameter (RAD), peak systolic velocity (PSV), end-diastolic velocity (EDV) and resistance index (RI) were measured. Results: 69 patients underwent TCC. Mean age was 54 years, 67% were male, 80% hypertensive, 65% diabetic. Follow-up at third month showed one total RAO (1.45%) and mean RAD of the remaining patients was significantly reduced from 2.2+0.03 mm to 2.1+0.03 mm (p=0.001) but none had any symptom or sign of ischemic hand. PSV, EDV & RI were not significantly altered. Reduction of RAD (to <2.0 mm) were significantly higher in female (p=0.032), but no association was found in presence of diabetes or its duration, hypertension, dyslipidaemia, smoking, peripheral vascular disease. The size & number of catheters used or duration of vascular access sheath kept in the artery did not affect the reduction of RAD.Conclusion: The mean RAD of the study was smaller than other study population, but incidence of RAO is very low. RAD was significantly reduced after procedure without any clinical evidence of ischemia or alteration of flow velocity. Female sex was the only factor found to be associated with reduction of RAD in this study.University Heart Journal Vol. 10, No. 2, July 2014; 66-72

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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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Effect of Continuous Quality Improvement Analysis on the Delivery of Primary Percutaneous Transluminal Coronary Angioplasty for Acute Myocardial Infarction

Cited by 80 publications

References 14 publications

Critical pathways in the emergency department improve treatment modalities for patients with ST‐elevation myocardial infarction in a European hospital

Critical pathways in the emergency department improve treatment modalities for patients with ST‐elevation myocardial infarction in a European hospital

Radial Artery Patency after Trans-radial Cardiac Catheterization in a Bangladeshi Population

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

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