Using a Systemwide Care Path to Enhance Compliance with Guidelines for Acute Myocardial Infarction
Abstract:Background: Several acute myocardial infarction (MI) guidelines and policy statements have been developed, but compliance rates are suboptimal. The cardiology section at Gundersen Lutheran Medical Center (La Crosse, Wisconsin) used a systemwide approach to enhance compliance with guidelines.
Methods and results: Data were collected prospectively for a 4-year period (May 15, 1995–May 15, 1999) for all patients presenting with acute MI. In 1995 a multidisciplinary team developed protocols for each phase of MI management and designed clinical care paths with builtin accountability. The initiative resulted in improvements in all phases of acute MI care and met the benchmark recommendations in mean time to electrocardiogram, thrombolytic therapy, and aspirin and beta-blocker administration. Rates of prescriptions for secondary prevention were 92% for aspirin and beta-blocker and 97% for smoking cessation education at 4 years.
Summary: The care path for acute MI involved multiple disciplines and empowerment of nonspecialists and nonphysician practitioners during development and implementation, as well as continual education and retraining. The care path led to several improvements in performance scores. These findings indicate that the recommendations as set forth in the American College of Cardiology (ACC) and the American Heart Association (AHA) guidelines for managing acute MI are realistic and achievable, and they do not require additional resources.
Document Type: Research Article
Publication date: 2003-05-01
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David W. Baker, MD, MPH, FACP, executive vice president for the Division of Healthcare Quality Evaluation at The Joint Commission, is the inaugural editor-in-chief of The Joint Commission Journal on Quality and Patient Safety.
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