The impact of emergency department structure and care processes in delivering care for non-ST-segment elevation acute coronary syndromes.
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.
Mehta
Rajendra H
RH
Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA. mehta007@dcri.duke.edu
Newby
L Kristin
LK
Patel
Yogin
Y
Hoekstra
James W
JW
Miller
Chadwick D
CD
Chen
Anita Y
AY
Lytle
Barbara L
BL
Diercks
Deborah B
DB
Summers
Richard L
RL
Brogan
Gerard X
GX
Peacock
W Frank
WF
Pollack
Charles V
CV
Roe
Matthew T
MT
Peterson
Eric D
ED
Ohman
E Magnus
EM
Gibler
W Brian
WB
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