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

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 a...

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Autores principales: Gopinath, Bharath, Kumar, Akshay, Sah, Rajesh, Bhoi, Sanjeev, Jamshed, Nayer, Ekka, Meera, Aggarwal, Praveen, Deorari, Ashok, Bhargava, Balram, Kappagantu, Vignan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9345032/
https://www.ncbi.nlm.nih.gov/pubmed/35914815
http://dx.doi.org/10.1136/bmjoq-2021-001764
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author Gopinath, Bharath
Kumar, Akshay
Sah, Rajesh
Bhoi, Sanjeev
Jamshed, Nayer
Ekka, Meera
Aggarwal, Praveen
Deorari, Ashok
Bhargava, Balram
Kappagantu, Vignan
author_facet Gopinath, Bharath
Kumar, Akshay
Sah, Rajesh
Bhoi, Sanjeev
Jamshed, Nayer
Ekka, Meera
Aggarwal, Praveen
Deorari, Ashok
Bhargava, Balram
Kappagantu, Vignan
author_sort Gopinath, Bharath
collection PubMed
description 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.
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spelling pubmed-93450322022-08-19 Strengthening emergency care systems to improve patient care for ST-elevation myocardial infarction (STEMI) at a high-volume tertiary care centre in India Gopinath, Bharath Kumar, Akshay Sah, Rajesh Bhoi, Sanjeev Jamshed, Nayer Ekka, Meera Aggarwal, Praveen Deorari, Ashok Bhargava, Balram Kappagantu, Vignan BMJ Open Qual Original Research 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. BMJ Publishing Group 2022-08-01 /pmc/articles/PMC9345032/ /pubmed/35914815 http://dx.doi.org/10.1136/bmjoq-2021-001764 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Original Research
Gopinath, Bharath
Kumar, Akshay
Sah, Rajesh
Bhoi, Sanjeev
Jamshed, Nayer
Ekka, Meera
Aggarwal, Praveen
Deorari, Ashok
Bhargava, Balram
Kappagantu, Vignan
Strengthening emergency care systems to improve patient care for ST-elevation myocardial infarction (STEMI) at a high-volume tertiary care centre in India
title Strengthening emergency care systems to improve patient care for ST-elevation myocardial infarction (STEMI) at a high-volume tertiary care centre in India
title_full Strengthening emergency care systems to improve patient care for ST-elevation myocardial infarction (STEMI) at a high-volume tertiary care centre in India
title_fullStr Strengthening emergency care systems to improve patient care for ST-elevation myocardial infarction (STEMI) at a high-volume tertiary care centre in India
title_full_unstemmed Strengthening emergency care systems to improve patient care for ST-elevation myocardial infarction (STEMI) at a high-volume tertiary care centre in India
title_short Strengthening emergency care systems to improve patient care for ST-elevation myocardial infarction (STEMI) at a high-volume tertiary care centre in India
title_sort strengthening emergency care systems to improve patient care for st-elevation myocardial infarction (stemi) at a high-volume tertiary care centre in india
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9345032/
https://www.ncbi.nlm.nih.gov/pubmed/35914815
http://dx.doi.org/10.1136/bmjoq-2021-001764
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