Thursday, April 30, 2009

Improved Efficiency in Acute

Improved Efficiency in Acute Myocardial Infarction Care Through Commitment to Emergency Department Initiated Primary
Study objective: Demonstrate improved efficiency of initial and subsequent in-hospital care following emergency department (ED) physician-initiated primary angioplasty (1°PCI).
Methods: An observational study was undertaken in ST-elevation myocardial infarction patients presenting to a community hospital emergency department. Outcomes of patients who received ED physician-directed 1°PCI were compared with patients previously treated by a mix of ED physician and cardiologist co-determined thrombolysis or 1°PCI. A process improvement initiative supported the change to ED-directed 1°PCI.
Results: The study included 287 eligible acute reperfusion patients. Median door-to-balloon time (MDBT) improved from 88 minutes (95% CI, 80-96) to 61 minutes (95% CI, 57-70;p <>p <>p = 0.0039), angiotensin-converting-enzyme inhibitor (p <>p = 0.0039), with favorable trends in survival to discharge, and 30-day major adverse cardiac events (MACE).
Conclusions: Conversion to ED physician-initiated 1°PCI for ST-elevation myocardial infarction significantly improved efficiency of care as measured by MDBT, NSI and LOS. Effectiveness measures, including survival to discharge, discharge medications and 30-day MACE, demonstrated improvement or favorable trends.

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