Effect of Continuous Quality Improvement Methods on Reducing Triage to Thrombolytic Interval for Acute Myocardial Infarction

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Abstract
To assess the timeliness of thrombolytic therapy in the ED for selected patients with acute myocardial infarction (AMI) following continuous quality improvement (CQI) interventions. A retrospective, historical comparison study was performed of triage-to-thrombolytic time intervals for AMI patients using chart review for data collection. Patients treated after implementation of the CQI process vs a historical control group were compared. The patients with AMI who had received thrombolytics during the one-year period prior to the CQI interventions and who had documentation of time intervals served as the control group. The patients treated during a four-month period, beginning about one and a half years following introduction of the CQI interventions, served as the intervention group. Interventions included: a triage protocol, CQI review, and staff feedback. The mean triage-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 also 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 therapy within 60 minutes, and 39% within 30 minutes, whereas 39% of the control group received thrombolytic therapy within 60 minutes, and 3% within 30 minutes. The implementation of CQI techniques, including 100% chart review, intensive systems analysis, and staff feedback, had a positive effect on the timeliness of thrombolytic therapy for the ED patients who had AMI. As a result, most (79%) of the patients received therapy within the 60-minute time window recommended currently by the American Heart Association.

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