Strengthening emergency care systems to improve patient care for ST-elevation myocardial infarction (STEMI) at a high-volume tertiary care centre in India

BMJ Open Quality

article

Bharath Gopinath¹  Akshay Kumar¹  Rajesh Sah²  Sanjeev Bhoi¹  Nayer Jamshed¹  Meera Ekka¹  Praveen Aggarwal¹  Ashok Deorari³  Balram Bhargava⁴  Vignan Kappagantu¹ 

[1] Department of Emergency Medicine , All India Institute of Medical Sciences;Department of Emergency Medicine , BP Koirala Institute of Health Sciences;Department of Paediatrics , All India Institute of Medical Sciences;Indian Council of Medical Research

关键词: quality improvement;    emergency department;    time-to-treatment;   

DOI  :  10.1136/bmjoq-2021-001764

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

Background ST-elevation myocardial infarction (STEMI) is a highly time-sensitive and life-threatening condition. Early recognition and timely management are challenging in a busy emergency department (ED), especially in low/middle-income countries where emergency systems are often fragmented. The aim of our quality improvement (QI) project was to increase the percentage of patients with STEMI undergoing primary percutaneous coronary intervention (PCI) with door to balloon (D2B) time of <90 min by 30% over 12 months.Methods As part of the first step in QI, baseline data were collected at different points in the process of care. Using process maps and fishbone analysis, delays in patient registration, ECG and communication with cardiology were identified as some bottlenecks, and change ideas were tested using plan–do–study–act cycles using point-of-care QI methodology. The majority of the change ideas focused on interventions in the ED like strengthening triage, training frontline staff, early diagnosis and quick transportation of patients.Results During the baseline phase, 22.22% of patients were found to have a D2B time of <90 min. We achieved an increase of 47.78% in patients receiving PCI within 90 min and hence increased to 70% at the end of the intervention phase. Data collected for 4 months after the intervention phase were found to have sustained the effort.Conclusion Significant improvement in the door to reperfusion time resulted from a meticulous assessment of emergency care processes by drawing process flow chart and implementation of change ideas like introduction of fast-track policy for patients with chest pain, reducing staff turnover in the triage area, formal training of staff, continuous engagement with cardiology team and by interchanging of processes which led to a reduction in time to ECG.

【 授权许可】

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