Optimising care of acute coronary syndromes in three Australian hospitals.
OBJECTIVE
To improve quality of in-hospital care of patients with acute coronary syndromes using a multifaceted quality improvement program.


METHODS
Prospective, before and after study of the effects of quality improvement interventions between October 2000 and August 2002. Quality of care of patients admitted between 1 October 2000 and 16 April 2001 (baseline) was compared with that of those admitted between 15 February 2002 and 31 August 2002 (post-intervention).


METHODS
Three teaching hospitals in Brisbane, Australia.


METHODS
Consecutive patients (n = 1594) admitted to hospital with acute coronary syndrome [mean age 68 years (SD 14 years); 65% males].


METHODS
Clinical guidelines, reminder tools, and educational interventions; 6-monthly performance feedback; pharmacist-mediated patient education program; and facilitation of multidisciplinary review of work practices.


METHODS
Changes in key quality indicators relating to timing of electrocardiogram (ECG) and thrombolysis in emergency departments, serum lipid measurement, prescription of adjunctive drugs, and secondary prevention.


RESULTS
Comparing post-intervention with baseline patients, increases occurred in the proportions of eligible patients: (i) undergoing timely ECG (70% versus 61%; P = 0.04); (ii) prescribed angiotensin-converting enzyme inhibitors (70% versus 60%; P = 0.002) and lipid-lowering agents (77% versus 68%; P = 0.005); (iii) receiving cardiac counselling in hospital (57% versus 48%; P = 0.009); and (iv) referred to cardiac rehabilitation (17% versus 8%; P < 0.001).


CONCLUSIONS
Multifaceted approaches can improve care processes for patients hospitalized with acute coronary syndromes. Care processes under direct clinician control changed more quickly than those reliant on complex system factors. Identifying and overcoming organizational impediments to quality improvement deserves greater attention.
Scott
Ian A
IA
Department of Internal Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia. ian_scott@health.qld.gov.au
Denaro
Charles P
CP
Hickey
Annabel C
AC
Bennett
Cameron
C
Mudge
Alison M
AM
Sanders
Daniela C
DC
Thiele
Justine
J
Flores
Judy L
JL
D000208:Acute Disease; D000368:Aged; D001315:Australia; D016507:Cardiology Service, Hospital / Q000592:standards*; D003327:Coronary Disease / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence; D006784:Hospitals, Teaching / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care