Using a systemwide care path to enhance compliance with guidelines for acute myocardial infarction.
BACKGROUND
Several acute myocardial infarction (MI) guidelines and policy statements have been developed, but compliance rates are suboptimal. The cardiology section at Gundersen Lutheran Medical Center (La Crosse, Wisconsin) used a systemwide approach to enhance compliance with guidelines.


RESULTS
Data were collected prospectively for a 4-year period (May 15, 1995-May 15, 1999) for all patients presenting with acute MI. In 1995 a multidisciplinary team developed protocols for each phase of MI management and designed clinical care paths with built-in accountability. The initiative resulted in improvements in all phases of acute MI care and met the benchmark recommendations in mean time to electrocardiogram, thrombolytic therapy, and aspirin and beta-blocker administration. Rates of prescriptions for secondary prevention were 92% for aspirin and beta-blocker and 97% for smoking cessation education at 4 years.


CONCLUSIONS
The care path for acute MI involved multiple disciplines and empowerment of nonspecialists and nonphysician practitioners during development and implementation, as well as continual education and retraining. The care path led to several improvements in performance scores. These findings indicate that the recommendations as set forth in the American College of Cardiology (ACC) and the American Heart Association (AHA) guidelines for managing acute MI are realistic and achievable, and they do not require additional resources.
Heart Failure Clinic, Gundersen Lutheran Medical Center, La Crosse, Wisconsin, USA. koakosah@gundluth.org
Kwame O
KO
Akosah
Diane E
DE
Larson
Ward M
WM
Brown
Kristine M
KM
Paul
Ana
A
Schaper
Robert M
RM
Green
D000208:Acute Disease; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D019985:Benchmarking; D016507:Cardiology Service, Hospital / Q000592:standards*; D002985:Clinical Protocols; D004562:Electrocardiography / Q000706:statistics & numerical data; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006764:Hospitals, Community / Q000592:standards; D006801:Humans; D015274:Interdepartmental Relations; D008332:Management Quality Circles; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000188:drug therapy / Q000517:prevention & control / Q000628:therapy*; D010353:Patient Education as Topic; D011446:Prospective Studies; D016540:Smoking Cessation / Q000706:statistics & numerical data; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data; D013997:Time Factors; D017749:Total Quality Management / Q000458:organization & administration*; D014922:Wisconsin
D000319:Adrenergic beta-Antagonists; D001241:Aspirin