The impact of emergency department structure and care processes in delivering care for non–ST-segment elevation acute coronary syndromes - 18/08/11
, L. Kristin Newby, MD, MHS a, ⁎, Yogin Patel, MD, MBA a, James W. Hoekstra, MD b, Chadwick D. Miller, MD b, Anita Y. Chen, MS a, Barbara L. Lytle, MS a, Deborah B. Diercks, MD c, Richard L. Summers, MD d, Gerard X. Brogan, MD e, W. Frank Peacock, MD f, Charles V. Pollack, MD, MA g, Matthew T. Roe, MD, MHS a, Eric D. Peterson, MD, MPH a, E. Magnus Ohman, MD h, W. Brian Gibler, MD ifor the CRUSADE Investigators
Résumé |
Background |
We sought to assess the influence of emergency department (ED) structure and care processes on adherence to practice guidelines for the treatment of patients with non–ST-segment elevation acute coronary syndromes.
Methods |
We surveyed emergency physicians and nurses from 316 hospitals participating in the CRUSADE Quality Improvement Initiative and used multivariable modeling to correlate ED-specific characteristics with guidelines adherence.
Results |
Factors that were significantly associated with improved guidelines adherence included collaboration between emergency physicians and hospital administration, northeast region, adequate nursing support, use of locum tenens physicians, an independent ED (not a division of another clinical department), and use of a care algorithm for acute coronary syndromes.
Conclusions |
Quality improvement strategies that have the full support of hospital administration, focus on increasing collaboration between emergency physicians and other health care providers, and specified protocol-driven management algorithm may be the most successful methods for improving the care and outcomes of patients with non–ST-segment elevation acute coronary syndromes.
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| CRUSADE is funded by the Schering-Plough Corporation, Kenilworth, NJ. Bristol-Myers Squibb/Sanofi-Aventis Pharmaceuticals Partnership, New York, NY and Paris, France, provides additional funding support. Millennium Pharmaceuticals, Inc, Cambridge, MA also provided funding for this work. |
Vol 152 - N° 4
P. 648-660 - octobre 2006 Retour au numéro
Article précédent
- Prevalence, predictors, and outcomes of patients with non–ST-segment elevation myocardial infarction and insignificant coronary artery disease: Results from the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines (CRUSADE) initiative
- Manesh R. Patel, Anita Y. Chen, Eric D. Peterson, L. Kristin Newby, Charles V. Pollack, Ralph G. Brindis, C. Michael Gibson, Neal S. Kleiman, Jorge F. Saucedo, Deepak L. Bhatt, W. Brian Gibler, E. Magnus Ohman, Robert A. Harrington, Matthew T. Roe
- Rationale for establishing regional ST-elevation myocardial infarction receiving center (SRC) networks
- Ivan C. Rokos, David M. Larson, Timothy D. Henry, William J. Koenig, Marc Eckstein, William J. French, Christopher B. Granger, Matthew T. Roe
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