University of Tasmania
Browse

File(s) under permanent embargo

Do clinical pathways enhance access to evidence-based acute myocardial infarction treatment in rural emergency departments?ajr_1262 59..66

journal contribution
posted on 2023-05-18, 06:17 authored by Leigh Kinsman, Rotter, T, Willis, J, Snow, PC, Buykx, P, Humphreys, JS

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.

History

Publication title

Australian Journal of Rural Health

Volume

20

Pagination

59-66

ISSN

1038-5282

Department/School

School of Nursing

Publisher

Wiley-Blackwell Publishing Asia

Place of publication

Australian

Rights statement

Copyright 2012 The Authors Australian Journal of Rural Health and Copyright 2012 National Rural Health Alliance Inc.

Repository Status

  • Restricted

Socio-economic Objectives

Nursing

Usage metrics

    University Of Tasmania

    Exports

    RefWorks
    BibTeX
    Ref. manager
    Endnote
    DataCite
    NLM
    DC