Optimising care of acute coronary syndromes in three Australian hospitals

Scott, Ian A., Denaro, Charles P., Hickey, Annabel C., Bennett, Cameron, Mudge, Alison M., Sanders, Daniela C., Thiele, Justine and Flores, Judy L. (2004) Optimising care of acute coronary syndromes in three Australian hospitals. International Journal For Quality In Health Care, 16 4: 275-284. doi:10.1093/intqhc/mzh051

Author Scott, Ian A.
Denaro, Charles P.
Hickey, Annabel C.
Bennett, Cameron
Mudge, Alison M.
Sanders, Daniela C.
Thiele, Justine
Flores, Judy L.
Title Optimising care of acute coronary syndromes in three Australian hospitals
Journal name International Journal For Quality In Health Care   Check publisher's open access policy
ISSN 1353-4505
Publication date 2004
Sub-type Article (original research)
DOI 10.1093/intqhc/mzh051
Volume 16
Issue 4
Start page 275
End page 284
Total pages 10
Editor R. H. Palmer
Place of publication USA
Publisher Oxford University Press
Collection year 2004
Language eng
Subject C1
321208 Primary Health Care
730399 Health and support services not elsewhere classified
Abstract Objective. To improve quality of in-hospital care of patients with acute coronary syndromes using a multifaceted quality improvement program. Design. Prospective, before and after study of the effects of quality improvement interventions between October 2000 and August 2002. Quality of care of patients admitted between 1 October 2000 and 16 April 2001 (baseline) was compared with that of those admitted between 15 February 2002 and 31 August 2002 (post-intervention). Setting. Three teaching hospitals in Brisbane, Australia. Study participants. Consecutive patients (n = 1594) admitted to hospital with acute coronary syndrome [mean age 68 years (SD 14 years); 65% males]. Interventions. Clinical guidelines, reminder tools, and educational interventions; 6-monthly performance feedback; pharmacist-mediated patient education program; and facilitation of multidisciplinary review of work practices. Main outcome measures. Changes in key quality indicators relating to timing of electrocardiogram (ECG) and thrombolysis in emergency departments, serum lipid measurement, prescription of adjunctive drugs, and secondary prevention. Results. Comparing post-intervention with baseline patients, increases occurred in the proportions of eligible patients: (i) undergoing timely ECG (70% versus 61%; P = 0.04); (ii) prescribed angiotensin-converting enzyme inhibitors (70% versus 60%; P = 0.002) and lipid-lowering agents (77% versus 68%; P = 0.005); (iii) receiving cardiac counselling in hospital (57% versus 48%; P = 0.009); and (iv) referred to cardiac rehabilitation (17% versus 8%; P < 0.001). Conclusions. Multifaceted approaches can improve care processes for patients hospitalized with acute coronary syndromes. Care processes under direct clinician control changed more quickly than those reliant on complex system factors. Identifying and overcoming organizational impediments to quality improvement deserves greater attention.
Keyword Health Care Sciences & Services
Health Policy & Services
Acute Coronary Syndrome
In-hospital Care
Quality Improvement
Acute Myocardial-infarction
Cooperative Cardiovascular Project
National Registry
Global Registry
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
2005 Higher Education Research Data Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 4 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 8 times in Scopus Article | Citations
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Created: Wed, 15 Aug 2007, 03:31:11 EST