Do clinical pathways enhance access to evidence-based acute myocardial infarction treatment in rural emergency departments?

Kinsman, Leigh D., Rotter, Thomas, Willis, Jon, Snow, Pamela C., Buykx, Penny and Humphreys, John S. (2012) Do clinical pathways enhance access to evidence-based acute myocardial infarction treatment in rural emergency departments?. Australian Journal of Rural Health, 20 2: 59-66.


Author Kinsman, Leigh D.
Rotter, Thomas
Willis, Jon
Snow, Pamela C.
Buykx, Penny
Humphreys, John S.
Title Do clinical pathways enhance access to evidence-based acute myocardial infarction treatment in rural emergency departments?
Journal name Australian Journal of Rural Health  (ERA 2012 Listed)    (ERA 2010 Rank B)   Check publisher's open access policy
Publication date 2012-04
Sub-type Article
DOI 10.1111/j.1440-1584.2012.01262.x
Volume number 20
Issue number 2
ISSN 1038-5282; 1440-1584
Start page 59
End page 66
Total pages 8
Place of publication Richmond, Vic., Australia
Publisher Wiley-Blackwell Publishing
Collection year 2013
Language eng
Formatted abstract Objective: The objective of this study is to measure the impact of a five-step implementation process for an acute myocardial infarction (AMI) clinical pathway (CPW) on thrombolytic administration in rural emergency departments.
Design: Cluster randomised controlled trial.
Setting: Six rural Victorian emergency departments participated.
Intervention: The five-step CPW implementation process comprised (i) engaging clinicians; (ii) CPW development; (iii) reminders; (iv) education; and (v) audit and feedback.
Main outcome measures: The impact of the intervention was assessed by measuring the proportion of eligible AMI patients receiving a thrombolytic and time to thrombolysis and electrocardiogram.
Results: Nine hundred and fifteen medical records were audited, producing a final sample of 108 patients eligible for thrombolysis. There was no significant difference between intervention and control groups for median door-to-needle time (29 mins versus 29 mins; P = 0.632), proportion of those eligible receiving a thrombolytic (78% versus 84%; P = 0.739), median time to electrocardiogram (7 mins versus 6 mins; P = 0.669) and other outcome measures. Results showed superior outcome measures than other published studies.
Conclusions: The lack of impact of the implementation process for a chest pain CPW on thrombolytic delivery or time to electrocardiogram in these rural hospitals can be explained by a ceiling effect in outcome measures but was also compromised by the small sample. Results suggest that quality of AMI treatment in rural emergency departments (EDs) is high and does not contribute to the worse mortality rate reported for AMIs in rural areas.
Keyword Clinical pathways
Emergency treatment
Myocardial infarction
Rural health services
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article
Collections: Aboriginal and Torres Strait Islander Studies Unit Publications
Non HERDC
 
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Created: Thu, 06 Dec 2012, 12:27:37 EST by Jon Willis on behalf of Aboriginal and Torres Strait Islander Studies Unit