EFFECT OF CONTINUOUS QUALITY IMPROVEMENT ANALYSIS ON THE DELIVERY OF PRIMARY PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY FOR ACUTE MYOCARDIAL-INFARCTION

A successful primary percutaneous transluminal coronary angioplasty (P TCA) program requires a learning process whereby the efficiency of the cardiac catheterization laboratory to deliver prompt intervention con be refined. The purpose of this study was to (1) quantify this : lear ning process in terms of shortening the time to reperfusion, (2) exami ne the changes in strategy that allowed for this, and (3) determine if expedited reperfusion by primary PTCA improved patient outcomes. A da tabase of all primary PTCA procedures was established in February 1, 1 994. Continuous quality assurance analysis was performed, and program modifications introduced as needed. Patients were separated into early (group A = February 1, 1994 through January 31, 1995) and late (group B1 = February 1, 1995 through June 31, 1995, and group B2 = July 1, 1 995 through December 31, 1995) cohorts. Time intervals to certain trea tment landmarks were compared among groups. In hospital outcomes were tabulated. Fifty-two consecutive patients were included (group A = 19, group B1 = 17, group B2 = 16). Time intervals shortened significantly (group A vs group B1 vs group B2) with the time from ; hospital prese ntation to first balloon inflation decreasing progressively (from 205 to 119 to 97 minutes; p <0.001). Most of this decrease was obtained by shortening the time from hospital presentation to xylocaine administr ation (158 to 85 to 72 minutes; p <0.005), although the time from xylo caine to first balloon inflation also decreased (from 47 to 33 to 24 m inutes; p <0.005). parallel decreases for in-hospital mortality (26% v s 0%; p = 0.004), adverse events (47% vs 18%; p = 0.05), and length of hospital stay (13.3 +/- 13.7 vs 8.4 +/- 4.4 days; p = NS) were demons trated for groups A versus B1 and B2. A learning effect following init iation of a primary PTCA program is demonstrated in which reperfusion was more rapidly achieved as the result of procedural changes directed by quality improvement analysis with a concurrent improvement in in-h ospital outcomes. (C) 1997 by Excerpta Medica, Inc.