Effect of continuous quality improvement methods on reducing triage to thrombolytic interval for acute myocardial infarction.
OBJECTIVE
To assess the timeliness of thrombolytic therapy in the ED for selected patients with acute myocardial infarction (AMI) following continuous quality improvement (CQI) interventions.


METHODS
A retrospective, historical comparison study was performed of triage-to-thrombolytic time intervals for AMI patients using chart review for data collection. Patients treated after implementation of the CQI process vs a historical control group were compared. The patients with AMI who had received thrombolytics during the one-year period prior to the CQI interventions and who had documentation of time intervals served as the control group. The patients treated during a four-month period, beginning about one and a half years following introduction of the CQI interventions, served as the intervention group. Interventions included: a triage protocol, CQI review, and staff feedback.


RESULTS
The mean triage-to-thrombolytic interval was longer for the control group (72 +/- 25 vs 40.0 +/- 22 min; p < 0.0001). The mean triage-to-ECG interval also was longer for the control group (16.5 +/- 8.9 vs 8.5 +/- 7.5 min; p < 0.0001). Most (79%) of the study group received thrombolytic therapy within 60 minutes, and 39% within 30 minutes, whereas 39% of the control group received thrombolytic therapy within 60 minutes, and 3% within 30 minutes.


CONCLUSIONS
The implementation of CQI techniques, including 100% chart review, intensive systems analysis, and staff feedback, had a positive effect on the timeliness of thrombolytic therapy for the ED patients who had AMI. As a result, most (79%) of the patients received therapy within the 60-minute time window recommended currently by the American Heart Association.
Department of Emergency Medicine, Medical Center of Delaware, Wilmington, USA.
S P
SP
Krall
C L
CL
Reese
L
L
Donahue
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D004334:Drug Administration Schedule; D004632:Emergency Medical Services / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D011786:Quality Control; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000592:standards; D013997:Time Factors; D016896:Treatment Outcome; D014218:Triage