Effect of Continuous Quality Improvement Methods on Reducing Triage to Thrombolytic Interval for Acute Myocardial Infarction

Krall, Scott P.; Reese, Charles L.; Donahue, Lorraine

doi:10.1111/j.1553-2712.1995.tb03597.x

Cited by 27 publications

(14 citation statements)

References 16 publications

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“…10 Lastly, there is a high likelihood that our stroke QI program influenced the use and safety of intravenous tPA in our hospital system, as has been demonstrated with thrombolytic therapy for myocardial infarction. 11 Our results suggest that intravenous tPA can be given safely to appropriate stroke patients at the community hospital level and that community physician performance improves over time.…”

Section: Discussionmentioning

confidence: 63%

Quality Improvement and Tissue-Type Plasminogen Activator for Acute Ischemic Stroke

Katzan

Hammer

Furlan³

et al. 2003

Stroke

169

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Background and Purpose— A systematic audit of intravenous tissue-type plasminogen activator (tPA) use and stroke outcomes in Cleveland, Ohio, during 1997–1998 demonstrated higher rates of symptomatic intracranial hemorrhage (ICH) than reported in the National Institute of Neurological Disorders and Stroke (NINDS) trial. We now report updated results of intravenous tPA use in the Cleveland Clinic Health System (CCHS). Methods— A stroke quality improvement program was initiated in the 9-hospital CCHS in 1999. A retrospective chart review for all stroke patients with primary International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes 434 and 436 admitted to the 9 hospitals from June 1999 to June 2000 was used to determine outcomes of patients treated with intravenous tPA. Results— Intravenous tPA was given to 18.8% of patients arriving within 3 hours of symptom onset. Protocol deviations occurred in 19.1% of patients given intravenous tPA. The symptomatic ICH rate was 6.4%. Conclusions— Since 1997, intravenous tPA use has increased, while the rates of symptomatic ICH and protocol deviations have decreased in the CCHS. The CCHS symptomatic ICH rate is now similar to that reported in the NINDS trial. These improvements occurred after initiation of a stroke quality improvement program.

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Section: Discussionmentioning

confidence: 63%

Quality Improvement and Tissue-Type Plasminogen Activator for Acute Ischemic Stroke

Katzan

Hammer

Furlan³

et al. 2003

Stroke

169

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“…[42][43][44][45] Once patients arrive for care, the in-hospital phase of delay to treatment is small compared with the other phases. 46 The longest phase of delay continues to be the time from symptom recognition to the decision to seek care, and it is in this phase that the most improvement could be achieved. …”

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confidence: 99%

Reducing Delay in Seeking Treatment by Patients With Acute Coronary Syndrome and Stroke

Moser¹,

et al. 2006

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Abstract-Patient delay in seeking treatment for acute coronary syndrome and stroke symptoms is the major factor limiting delivery of definitive treatment in these conditions. Despite decades of research and public education campaigns aimed at decreasing patient delay times, most patients still do not seek treatment in a timely manner. In this scientific statement, we summarize the evidence that (1) demonstrates the benefits of early treatment, (2) describes the extent of the problem of patient delay, (3) identifies the factors related to patient delay in seeking timely treatment, and (4) reveals the inadequacies of our current approaches to decreasing patient delay. Finally, we offer suggestions for clinical practice and future research. Key Words: AHA Scientific Statements Ⅲ acute coronary syndrome Ⅲ stroke Ⅲ delivery of health care D espite major advances in identifying effective treatments for heart attack and stroke, there are substantial difficulties in applying these treatments to care. The weak link in the chain of events leading to prompt and effective treatment is patient delay in seeking care. More than 50% of the 1.2 million people who suffer an acute myocardial infarction (AMI) or coronary death each year in the United States die in an emergency department (ED) or before reaching a hospital within an hour of symptom onset. 1 About 700 000 individuals will have a stroke each year, 167 000 of those who have strokes will die, and more will suffer a major disability. 1 Of the stroke deaths that occur each year, almost half occur before the patient reaches the hospital. 2 Many of these deaths and significant disability could be prevented if patients received earlier treatment. 1,3 Although the benefits of early treatment of heart attack and stroke are clear, only a minority of eligible patients receive optimally timed treatment for their symptoms because of delay in seeking care. The development and use of appropriate interventions to decrease treatment-seeking delay by patients could produce important gains in reducing death and disability from heart attack and stroke. Unfortunately, efforts to date to develop effective interventions have met with disappointing results. 4 -6 Accordingly, the purpose of this statement is to summarize the evidence that demonstrates the benefits of early treatment, 1,2 describes the extent of the problem of patient delay, 3 identifies the factors related to patient delay in seeking timely treatment, and reveals the inadequacies of our current approaches to decreasing patient delay. 4 Finally, we offer suggestions for clinical practice and future research. Benefits of Early TreatmentThe burden of cardiovascular disease is growing worldwide. Ischemic heart disease is the No. 1 cause of death in the The findings and conclusions in this scientific statement are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention and the National Heart, Lung, and Blood Institute.The American Heart Association makes every effort to av...

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“…For example, Clawson and colleagues recently reported that, by providing emergency medical dispatchers with regular and objective performance feedback for a two-month period, their mean overall compliance score with dispatch protocols increased from 76% to 96%. 4 Other relevant ED CQI projects have been published, describing improvements in doorto-drug thrombolytic intervals, 5,6 EMS documentation, 7 patient length of stay and walkouts, 8,9 stat laboratory services, 10 radiograph callbacks, 11 and ED triage. 12 Our approach was to incorporate basic and time-proven CQI methodology into our initiative.…”

Section: Discussionmentioning

confidence: 99%

A Continuous Quality Improvement Approach to IL‐372 Documentation Compliance in an Academic Emergency Department, and Its Impact on Dictation Costs, Billing Practices, and Average Patient Length of Stay

Higgins¹,

Becker²

2000

Academic Emergency Medicine

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Abstract. Objective: To determine whether continuous quality improvement (CQI) methodology could improve and maintain IL-372 documentation compliance in an academic emergency department (ED). The impact on transcription costs, billing practices, and average patient length of stay was also analyzed. Methods: Baseline IL-372 compliance data were collected and shared with staff during a multidisciplinary educational session. Faculty dictation became mandatory. Pocket-sized dictation templates were provided. A Documentation Improvement Committee monitored outcomes. Each month of the study period, a compliance officer reviewed approximately 100 records. The following indicators were monitored: IL-372 compliance rates, dictation rates, transcription costs, down-coding rates, percentage of billable records, and average patient length of stay. Individualized results were provided to faculty. Results: During the ten-month study period, compliance rates increased from 60% to 100% (p-trend < 0.001), while dictation rates increased from 69% to 100% (p < 0.001). Rates of down-coding adjustments improved from 54% to 2% (p-trend < 0.001). The percentage of billable records increased from 65% to 100% (p-trend < 0.001). Transcription costs increased a modest 16%. The average patient length of stay remained unchanged. Conclusion: The application of CQI methodology, combined with the availability of dictation, resulted in sustained improvement in IL-372 compliance. This was associated with a parallel increase in dictation rates, although concurrent transcription costs increased only modestly. The percentage of billable records increased, while the number of charts requiring down-coding decreased, both beneficial outcomes. Average length of stay was not adversely impacted by this added documentation requirement.

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Effect of Continuous Quality Improvement Methods on Reducing Triage to Thrombolytic Interval for Acute Myocardial Infarction

Cited by 27 publications

References 16 publications

Quality Improvement and Tissue-Type Plasminogen Activator for Acute Ischemic Stroke

Quality Improvement and Tissue-Type Plasminogen Activator for Acute Ischemic Stroke

Reducing Delay in Seeking Treatment by Patients With Acute Coronary Syndrome and Stroke

A Continuous Quality Improvement Approach to IL‐372 Documentation Compliance in an Academic Emergency Department, and Its Impact on Dictation Costs, Billing Practices, and Average Patient Length of Stay

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