title: The impact of emergency department structure and care processes in delivering care for non-ST-segment elevation acute coronary syndromes.
abstract: BACKGROUND
  We sought to assess the influence of emergency department (ED) structure and care processes on adherence to practice guidelines for the treatment of patients with non-ST-segment elevation acute coronary syndromes.
  
  
  METHODS
  We surveyed emergency physicians and nurses from 316 hospitals participating in the CRUSADE Quality Improvement Initiative and used multivariable modeling to correlate ED-specific characteristics with guidelines adherence.
  
  
  RESULTS
  Factors that were significantly associated with improved guidelines adherence included collaboration between emergency physicians and hospital administration, northeast region, adequate nursing support, use of locum tenens physicians, an independent ED (not a division of another clinical department), and use of a care algorithm for acute coronary syndromes.
  
  
  CONCLUSIONS
  Quality improvement strategies that have the full support of hospital administration, focus on increasing collaboration between emergency physicians and other health care providers, and specified protocol-driven management algorithm may be the most successful methods for improving the care and outcomes of patients with non-ST-segment elevation acute coronary syndromes.
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA. mehta007@dcri.duke.edu
authors.forename: Rajendra H
authors.initials: RH
authors.lastname: Mehta
authors.forename: L Kristin
authors.initials: LK
authors.lastname: Newby
authors.forename: Yogin
authors.initials: Y
authors.lastname: Patel
authors.forename: James W
authors.initials: JW
authors.lastname: Hoekstra
authors.forename: Chadwick D
authors.initials: CD
authors.lastname: Miller
authors.forename: Anita Y
authors.initials: AY
authors.lastname: Chen
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Lytle
authors.forename: Deborah B
authors.initials: DB
authors.lastname: Diercks
authors.forename: Richard L
authors.initials: RL
authors.lastname: Summers
authors.forename: Gerard X
authors.initials: GX
authors.lastname: Brogan
authors.forename: W Frank
authors.initials: WF
authors.lastname: Peacock
authors.forename: Charles V
authors.initials: CV
authors.lastname: Pollack
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Roe
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: E Magnus
authors.initials: EM
authors.lastname: Ohman
authors.forename: W Brian
authors.initials: WB
authors.lastname: Gibler
mesh_terms: D000208:Acute Disease; D000368:Aged; D000465:Algorithms; D002985:Clinical Protocols; D003299:Cooperative Behavior; D003327:Coronary Disease / Q000175:diagnosis* / Q000628:therapy*; D003625:Data Collection; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000592:standards; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D019983:Guideline Adherence; D006282:Health Personnel; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D011795:Surveys and Questionnaires; D013577:Syndrome