A continuous quality improvement (CQI) project was conducted at Soroka Medical Center in Beer-Sheva, Israel, in an effort to identify and address causes of delays in thrombolytic therapy in patients arriving at a high-volume (160,000 patients per year) emergency department with acute myocardial infarction and thereby reduce the « door-to needle time » (DTNT).
Preintervention survey, peri-intervention process redesign, postintervention evaluation, and follow-up evaluation.
CQI team : The CQI team followed a seven-step protocol : problem definition, present-state screening, factors analysis, solution development, outcome evaluation, standardization, and conclusions.
A DTNT of 45 minutes was considered acceptable for this data set, and accordingly, patients were divided into an « early » group (n=50, DTNT<45 minutes), and a « late » group (n=50, DTNT>=45 minutes).
After the CQI intervention, the mean DTNT decreased from 61.8+/-32.5 (mean+/-standard deviation) to 47.6+/-18.5 minutes (p<0.0029).
The prolonged DTNT time intervals of the late versus the early groups was primarily due to extended decision-making time (36.0+/-22.7 versus 13.6+/6.7 minutes, p<0.003), followed by time until therapy was initiated (26.2+/-14.2 versus 11.1+/-5.8 minutes, p<0.002). (...)
Mots-clés Pascal : Infarctus, Cardiopathie coronaire, Cardiopathie, Appareil circulatoire pathologie, Maladie, Soin, Israël, Moyen Orient, Asie, Monde, Milieu hospitalier, Urgence, Service hospitalier, Organisation hospitalière, Qualité, Aspect politique, Géographie
Mots-clés Pascal anglais : Infarct, Coronary heart disease, Heart disease, Cardiovascular disease, Disease, Care, Israel, Middle east, Asia, World, Hospital environment, Emergency, Hospital ward, Hospital organization, Quality, Political aspect, Geography
Notice produite par :
ORS Auvergne - Observatoire Régional de la Santé d'Auvergne
Code Inist : 002B30A11. Création : 11/09/1998.