title: Standard admission orders can improve the management of acute myocardial infarction.
abstract: OBJECTIVE
  To evaluate whether the use of standard admission orders for patients admitted with acute myocardial infarction (AMI) is associated with better hospital quality of care.
  
  
  METHODS
  Secondary analysis of a population-based database derived from a large cluster randomized AMI quality improvement trial.
  
  
  METHODS
  Seventy-eight acute care hospital corporations located in Ontario, Canada.
  
  
  METHODS
  A total of 5338 patients with AMI admitted directly to the coronary care/intensive care units of participating hospitals in 2004/2005. Main outcome measure(s) Hospital performance on seven process-of-care measures and a combined composite process-of-care measure. Secondary outcomes were 30-day and 1-year mortality rates.
  
  
  RESULTS
  Most patients (81%) were treated with standard admission orders. These patients were more likely to receive four of seven identified process-of-care measures (P< 0.05), including fibrinolytics ≤ 30 min or primary percutaneous coronary intervention ≤ 90 min of arrival, fibrinolytics administration decided by emergency department physician, aspirin ≤ 6 h of arrival and lipid test ≤ 24 h. After propensity-score matching (for risk adjustment), use of standard admission orders was not associated with significantly lower 30-day or 1-year mortality. However, patients who met the composite process-of-care measure had lower 30-day and 1-year mortality (relative risk= 0.51 (95% confidence interval (CI): 0.40-0.67) and 0.70 (95% CI: 0.58-0.84), respectively).
  
  
  CONCLUSIONS
  In AMI, the use of standard admission orders was associated with improved hospital performance on several but not all acute process-of-care quality indicators. The utilization of standard admission orders should be considered as a strategy for improving hospital care in patients admitted with AMI.
authors.affiliation: Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue – G250, Toronto, Ontario, Canada.
authors.forename: Lusine
authors.initials: L
authors.lastname: Abrahamyan
authors.forename: Peter C
authors.initials: PC
authors.lastname: Austin
authors.forename: Linda R
authors.initials: LR
authors.lastname: Donovan
authors.forename: Jack V
authors.initials: JV
authors.lastname: Tu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000458:organization & administration* / Q000592:standards; D012307:Risk Factors