EFFECT OF CONTINUOUS QUALITY IMPROVEMENT METHODS ON REDUCING TRIAGE TO THROMBOLYTIC INTERVAL FOR ACUTE MYOCARDIAL-INFARCTION

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.