Quality of care of patients hospitalized with acute coronary syndromes.
BACKGROUND
Measurement and improvement of quality of care is a priority issue in health care. Patients hospitalized with acute coronary syndromes (ACS) constitute a high-risk population whose care, if shown to be suboptimal on the basis of available research evidence, may benefit from quality improvement interventions.


OBJECTIVE
To evaluate the quality of in-hospital care for patients with ACS, using explicit quality indicators.


METHODS
Retrospective case note review was undertaken of 397 patients admitted to three teaching hospitals in Brisbane, Queensland, Australia, between 1 October 2000 and 17 April 2001. The main outcome measures were 12 process-of-care quality indicators, calculated as either: (i) the proportion of all patients who received specific interventions or (ii) the proportion of ideal patients who received specific interventions (i.e. patients with clear indications and lacking contraindications).


RESULTS
Quality indicators with values above 80% included: (i) patient selection for thrombolysis (100%) and discharge prescription of beta-blockers (84%), (ii) antiplatelet agents (94%) and (iii) lipid-lowering agents (82%). Indicators with values between 50% and 80% included: (i) timely performance of electrocardiogram (ECG) on admission (61%), (ii) early coronary angiography (75%), (iii) measurement of serum lipids (71%) and (iv) discharge prescription of angiotensin-converting-enzyme (ACE) inhibitors (73%). Indicators with values <50% included: (i) timely administration of thrombolysis (35%), (ii) non-invasive risk assessment (23%) and (ii) formal in-hospital, and post-hospital cardiac rehabilitation (47% and 7%, respectively).


CONCLUSIONS
There were delays in performing ECG and administering thrombolysis to patients who presented to emergency departments with ACS. Improvement is warranted in use of non-invasive procedures for identifying high-risk patients who may benefit from coronary revascularization as well as use of serum lipid measurements, ACE inhibitors and cardiac rehabilitation.
Scott
I A
IA
Department of Internal Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia. ian_scott@health.qld.gov.au
Denaro
C P
CP
Flores
J L
JL
Bennett
C J
CJ
Hickey
A C
AC
Mudge
A M
AM
D000368:Aged; D000789:Angina, Unstable / Q000188:drug therapy / Q000628:therapy*; D016507:Cardiology Service, Hospital / Q000592:standards*; D005260:Female; D006760:Hospitalization; D006784:Hospitals, Teaching / Q000592:standards; D006801:Humans; D008297:Male; D008485:Medical Audit; D009203:Myocardial Infarction / Q000188:drug therapy / Q000628:therapy*; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D011793:Queensland; D013577:Syndrome; D015912:Thrombolytic Therapy