Development of STEMI Fast Track Service Model

Abstract

Background: ST-Elevation Myocardial Infarction (STEMI) is a critical issue in medicine which has increasing trend in mortality. Prompt management to confine the infarction area therefore decreases disease mortality.
Objective: to develop the STEMI fast tract service and evaluate the outcome
Study Design: Research and development
Method: There were four development phases of 1) situation analysis 2) nursing care plan development 3) care plan implementation to patient care process 4) outcome evaluation. There were 160 samples comprised of health care provider group (14 registered nurses in charge of STEMI patient care and 5 multidisciplinary team members) and 140 STEMI patients. Research tools were questionnaires for opinion survey, knowledge assessment and satisfaction survey. Performance checklist and quality of care record form were also included in this study. Data were analyzed and presented by frequency, percentage, mean with standard deviation and t-test.
Result: Explicit STEMI fast track service model was obtained in which covers patient care process from entry to discharge and post-discharge monitoring. Quality score according to AGREE instrument was 88.0%. After the service model implementation, registered nurses agreed with the developed service model and adherence rate to the service model was 95.83%. Knowledge score of nurse after service model implementation was significantly increased (p<0.01) and patient’s satisfaction was at high level. Rate of STEMI fast track enrollment within three hours was 56.38% and fibrinolytic treatment rate within thirty minutes increased from 46.3% to 60.2%. Mortality rate decreased from 13.1% to 10.9%.
Conclusion: The developed STEMI fast tract service model resulted in participation of patient care team to create patient care plan which covered patient’s requirement and better health care outcome. This study is applicable for clinical skill development in nursing and further enhances system effectiveness.