Sp. Krall et al., EFFECT OF CONTINUOUS QUALITY IMPROVEMENT METHODS ON REDUCING TRIAGE TO THROMBOLYTIC INTERVAL FOR ACUTE MYOCARDIAL-INFARCTION, Academic emergency medicine, 2(7), 1995, pp. 603-609
Objectives: To assess the timeliness of thrombolytic therapy in the ED
for selected patients with acute myocardial infarction (AMI) followin
g continuous quality improvement (CQI) interventions. Methods: A retro
spective, historical comparison study was performed of triage-to-throm
bolytic time intervals for AMI patients using chart review for data co
llection. Patients treated after implementation of the CQI process vs
a historical control group were compared. The patients with AMI who ha
d received thrombolytics during the one-year period prior to the CQI i
nterventions and who had documentation of time intervals served as the
control group. The patients treated during a four-month period, begin
ning about one and a half years following introduction of the CQI inte
rventions, served as the intervention group. Interventions included: a
triage protocol, CQI review, and staff feedback. Results: The mean tr
iage-to-thrombolytic interval was longer for the control group (72 +/-
25 vs 40.0 +/- 22 min; p < 0.0001). The mean triage-to-ECG interval a
lso was longer for the control group (16.5 +/- 8.9 vs 8.5 +/- 7.5 min;
p < 0.0001). Most (79%) of the study group received thrombolytic ther
apy within 60 minutes, and 39% within 30 minutes, whereas 39% of the c
ontrol group received thrombolytic therapy within 60 minutes, and 3% w
ithin 30 minutes. Conclusion: The implementation of CQI techniques, in
cluding 100% chart review, intensive systems analysis, and staff feedb
ack, had a positive effect on the timeliness of thrombolytic therapy f
or the ED patients who had AMI. As a result, most (79%) of the patient
s received therapy within the 60-minute time window recommended curren
tly by the American Heart Association.