PMID: 9651794Jul 4, 1998Paper

The "door-to-needle blitz" in acute myocardial infarction: the impact of a CQI project

The Joint Commission Journal on Quality Improvement
H GilutzG Rabinowitz

Abstract

A continuous quality improvement (CQI) project was conducted at Soroka Medical Center in Beer-Sheva, Israel, in an effort to identify and address causes of delays in thrombolytic therapy in patients arriving at a high-volume (160,000 patients per year) emergency department with acute myocardial infarction and thereby reduce the "door-to-needle time" (DTNT). The study had four phases: preintervention survey, peri-intervention process redesign, postintervention evaluation, and follow-up evaluation. CQI TEAM: The CQI team followed a seven-step protocol: problem definition, present-state screening, factors analysis, solution development, outcome evaluation, standardization, and conclusions. A DTNT of 45 minutes was considered acceptable for this data set, and accordingly, patients were divided into an "early" group (n = 50, DTNT < 45 minutes), and a "late" group (n = 50, DTNT > or = 45 minutes). After the CQI intervention, the mean DTNT decreased from 61.8 +/- 32.5 (mean +/- standard deviation) to 47.6 +/- 18.5 minutes (p < 0.029). The prolonged DTNT time intervals of the late versus the early groups was primarily due to extended decision-making time (36.0 +/- 22.7 versus 13.6 +/- 6.7 minutes, p < 0.003), followed by time until the...Continue Reading

References

Mar 1, 1995·International Journal for Quality in Health Care : Journal of the International Society for Quality in Health Care·K I Pettersen
Jun 1, 1995·Journal of the American College of Cardiology·W D Weaver
Jul 1, 1995·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·S P KrallL Donahue
Jan 1, 1996·Journal of Nursing Care Quality·D Oetker, C Cole

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Citations

Apr 6, 2006·Health Services Research·Bryan J WeinerJeffrey J Geppert
Nov 15, 2006·International Journal of Health Care Quality Assurance Incorporating Leadership in Health Services·S G ElkhuizenN S Klazinga

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