title: Achieving high quality in ST-segment elevation myocardial infarction care: one urban academic medical center experience.
abstract: Management of acute myocardial infarction with ST elevation (STEMI) remains a challenge for academic institutions. There are numerous factors at play from the time electrocardiogram is obtained to the time the patient arrives to a catheterization laboratory and the balloon is inflated. Academic hospitals that are located in large urban centers have to deal with staff living long distances from the facility, and therefore, assembling the catheterization team after-hours and on the weekends becomes a difficult task to achieve. There are other factors that contribute to time delays, such as, administering electrocardiograms in timely fashion, having emergency physicians activate the catheterization team, instead of contacting the cardiologist to discuss the case, and other time-sensitive factors. All of the aforementioned issues contribute to the delay. Yet, primary percutaneous coronary intervention is clearly demonstrated as the modality of choice in treatment of STEMI, which improves patient's morbidity and mortality. Therefore, it is imperative that institutions do all they can to improve their protocols and meet the core measures in the treatment of STEMI patients, including the door-to-balloon time of less than 90 minutes. Our institution started a quality improvement program for STEMI care in 1993 and has showed progressive improvement in use of aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, and other medication, culminating in 95% to 100% use of these medications in 2003-2004, when we operated in accordance with the Get With The Guidelines program. Door-to-balloon time in less than 90 minutes became a new phase in our quality improvement process, and we achieved 100% compliance in the last 2 years.
authors.affiliation: Department of Emergency Medicine, Rush University Medical Center, Chicago, IL 60612, USA. Yanina-Purim-Shem-Tov@rush.edu
authors.forename: Yanina A
authors.initials: YA
authors.lastname: Purim-Shem-Tov
authors.forename: Normal
authors.initials: N
authors.lastname: Melgoza
authors.forename: Janet
authors.initials: J
authors.lastname: Haw
authors.forename: Gary L
authors.initials: GL
authors.lastname: Schaer
authors.forename: James E
authors.initials: JE
authors.lastname: Calvin
authors.forename: Dino P
authors.initials: DP
authors.lastname: Rumoro
mesh_terms: D000046:Academic Medical Centers / Q000592:standards; D015906:Angioplasty, Balloon, Coronary / Q000379:methods / Q000592:standards; D006328:Cardiac Catheterization / Q000379:methods; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002985:Clinical Protocols / Q000592:standards; D019091:Critical Pathways / Q000592:standards; D057210:Delayed Diagnosis / Q000009:adverse effects / Q000517:prevention & control; D019468:Disease Management; D061345:Early Medical Intervention / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D004562:Electrocardiography / Q000379:methods*; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D019983:Guideline Adherence / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D058996:Quality Improvement; D013997:Time Factors
chemical_list: D002317:Cardiovascular Agents