Quality of Care for Patients With ST-Segment Elevation Myocardial Infarction Using Fast Track Service in Thailand

Songwut Sungbun; Noppawan Piaseu; Suphamas Partiprajak

doi:10.14456/rmj.2018.39

Authors

Songwut Sungbun Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Noppawan Piaseu Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Suphamas Partiprajak Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

DOI:

https://doi.org/10.14456/rmj.2018.39

Keywords:

STEMI, Quality of care, Emergency department, Community hospitals

Abstract

Background: The ST-segment elevation myocardial infarction (STEMI) fast track care recommend door to needle within 30 minutes. The current guideline is implemented in the community hospitals for timely reperfusion therapies, however, evaluation on its quality is limited.

Objective: To evaluate quality of care for patients with STEMI in community hospitals, Thailand.

Method: A descriptive design was conducted in three community hospitals, where distance from primary percutaneous coronary intervention (PCI)-capable hospital are more than 120 minutes. Consecutive sampling was used to select sample of patients with STEMI from October 1, 2016, to Mach 31, 2017. Data were collected from STEMI patients in 3 community hospitals using questionnaire and medical record reviews.

Results: Thirty-two STEMI patients participated in this study. The mean age of the patients was 62.5 ± 11.4 years. Most of them (87.5%) used self-transportation. Approximately 51.7% received streptokinase within time, while the average door to needle time was 48.4 minutes. The mean total ischemic time was 246.2 ± 365.7 minutes, and 18.8% of patients died in-hospital.

Conclusions: This study showed that door to needle time, door to balloon time, door to ECG, door to referral time, and total ischemic time were longer than recommended time. The main reasons were patients delay and system delay particular delayed diagnosis.

References

American College of Emergency Physicians; Society for Cardiovascular Angiography and Interventions, O'Gara PT, Kushner FG, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines. J Am Coll Cardiol. 2013;61(4):e78-e140. doi:10.1016/j.jacc.2012.11.019.

World Health Organization. Quality of care: A process for making strategiec choies in health system. Geneva, Switzerland: World Health Organization; 2006. https://www.who.int/management/quality/assurance/QualityCare_B.Def.pdf. Accessed June 7, 2018.

Pheerawong P. Efficacy of STEMI fast track management system. Medical Journal of Srisaket Surin Buriram Hospitals. 2014;29(1):13-22.

Srimahachota S, Boonyaratavej S, Kanjanavanit R, et al. Thai registry in acute coronary syndrome (TRACS) an extension of Thai acute coronary syndrome registry (TACS) group: lower in-hospital but still high mortality at one-year. J Med Assoc Thai. 2012;95(4):508-518.

Untaja P, Sindhu S. Evaluation project for factors associated successful access to treatment of the patients with ST-elevated myocardial infarction (STEMI) to improve emergency medical services system; 2011. https://www.niems.go.th/th/Upload/File/255907081003085669_bJ8PgJ0H84CNeiaD.pdf. Accessed June 7, 2018.

Sittisook S. The guideline management for patients with ischemic heart disease in Thailand. 2 nd ed. Bangkok, Thailand: The Heart Association of Thailand under the Royal Patronage; 2014. https://www.thaiheart.org/images/column_1291454908/Guideline%20for%20Ischemic%20Heart%20Disease%202104.pdf. Accessed June 7, 2018.

Donabedian A, Wheeler JR, Wyszewianski L. Quality, cost, and health: an integrative model. Med Care. 1982;20(10):975-992.

Ibanez B, Jame S, Agewell S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119-177. doi:10.1093/eurheartj/ehx393.

Thanasomboonpan S, Kraysubun C. ST-segment elevation myocardial infarction (STEMI) in non-PCI-capable hospital. The Journal of Prapokklao Hospital Clinical Medical Education Center. 2014;31(1): 30-42.

Alabas OA, Hall M, Dondo TB, et al. Long-term excess mortality associated with diabetes following acute myocardial infarction: a population-based cohort study. J Epidemiol Community Health. 2017;71(1):25-32. doi:10.1136/jech-2016-207402.

Dagres N, Hindricks G. Risk stratification after myocardial infarction: is left ventricular ejection fraction enough to prevent sudden cardiac death? Eur Heart J. 2013;34(26):1964-1971. doi:10.1093/eurheartj/eht109.

Wander GS, Chhabra ST. Chapter 24: Critical Analysis of Various Drugs Used for Thrombolytic Therapy in Acute Myocardial Infarction. In: Muruganathan A, ed. Medicine Update. New Delhi: Jaypee Brothers Medical; 2013:109-116. www.apiindia.org/medicine_update_2013/chap24.pdf. Accessed June 7, 2018.

Ascef BO, Izidoro JB, Almeida AM, Bahia Neto AF, Guerra Júnior AA, Acurcio FA. Effectiveness and safety of thrombolytic agents streptokinase, alteplase and tenecteplase in the treatment of acute myocardial infarction. Value in Health. 2016;19(7):A640-A648. doi:10.1016/j.jval.2016.09.1691.

Panduranga P, Al-Zakwani I, Sulaiman K, et al. Clinical profile and mortality of ST-segment elevation myocardial infarction patients receiving thrombolytic therapy in the Middle East. Heart Views. 2012;13(2):35-41. doi:10.4103/1995-705X.99224.

Denktas AE, Anderson HV, McCarthy J, et al. Total ischemic time: the correct focus of attention for optimal ST-segment elevation myocardial infarction care. JACC Cardiovasc Interv. 2011;4(6):599-604. doi:10.1016/j.jcin.2011.02.012.

Ministry of Public Health. Report key performance indicator of acute coronary syndrome; 2017. https://hdcservice.moph.go.th/hdc/reports/report_kpi.php?flag_kpi_level=2&flag_kpi_year=2015&source=kpi/kpi.php&id=12d5b6eef67669da17758ef281915cbb. Accessed June 7, 2018.

Pattarapongsin M. Results of treatment of ST- elevation myocardial infarction (STEMI) patients in Chaiyaphum. Maharat Nakhon Ratchasima Hospital Medical Bulletin. 2015;37(2):95-104.

Rungrangwarin J, Soonpayanon S, Kongsombun U. Development of fast track system for patients with STEMI in Phra Nakhon Si Ayutthaya province. Journal of Preventive Medicine Association of Thailand. 2016;6(1):1-14.

Sungbun S, Piasseu N, Partiprajak S. Need of stakeholders in fast-track care for st-segment elevation myocardial infarction. Thai Journal of Nursing Council. 2018;32(4).

Maneeprai J. Development of ST-elevation myocardial infarction care network in Kamphaeng Phet. Journal of Health Science. 2015;24(5):908-920.