Effectiveness of Fast Track System Development in ST Elevated Myocardial Infarction

Abstract

Background : Acute Myocardial Infarction is a critical issue in medicine. Prompt management to confine the infarction area.
Objective : The purposes of this study were to develop the STEMI fast tract service and evaluate the implementation of the model.
Study Design : Research and development
Methods : This was a developmental research composing of 4-steps process: 1) Situation analysis 2) Develop service model 3) Implementation the model to patient care process 4) outcome evaluation. There were 236 samples by purposive sampling with specific characteristics people, comprised of health care provider group (45 registered nurses in charge of STEMI patient care and 9multidisciplinary team members) and 182 STEMI patients. Research tools were questionnaires for opinion survey, knowledge assessment and satisfaction survey. Performance checklist and quality of care recorded. Data were analyzed and presented by frequency, percentage, mean with standard deviation and t-test and Chi-square.
Results : 1. The STEMI Fast Track Service Model consisting of 1) Network management system consists of the structure, scope of responsibility of the hospitals in the network in Surin Province. 2) The service system which consisted of standards for STEMI care, Fast track procedures, Clinical practice guideline, Long-distance consulting through application line and standing order: Protocol for STEMI, STEMI Center, STEMI nurse and Nursing care guideline. 3) Personnel Capacity Building System consisted of increasing knowledge of personnel, mentoring and the supervision system. 2. After the service model implementation, registered nurses agreed with the developed service model and adherence rate to the service model was 95.8%. Knowledge score of nurse after service model implementation was significantly increased from 14.1 to 18.2 (p=0.000). Rate of STEMI fast track increased form 78.3% to 92.1% (p=0.021), enrollment within three hours from 27.4% to 51.3% (p=0.002) and fibrinolytic treatment rate increased form 71.7% to 90.8%, rate door to needle time within thirty minutes increased from 10.4% to 31.6%. Mortality rate decreased from 12.3% to 10.5% (p=0.899), patient’s self-care knowledge score increased from 8.4 to9.9 (p=0.000) and satisfaction was at high level.
Conclusion : These studies suggest the benefits for caring patients.
Keywords : STEMI, care plan, development