TY - JOUR
T1 - Multicentre analysis of current ST-elevation myocardial infarction acute care pathways
AU - Tra, Joppe
AU - de Blok, Carolien
AU - Van Der Wulp, Ineke
AU - De Bruijne, Martine C.
AU - Wagner, Cordula
PY - 2017/1/1
Y1 - 2017/1/1
N2 - Background: Rapid reperfusion with percutaneous coronary intervention (PCI) is vital for patients with ST segment elevation myocardial infarction (STEMI). However, the guideline-recommended time targets are regularly exceeded. The goal of this study was to gain insight into how Dutch PCI centres try to achieve these time targets by comparing their care processes with one another and with the European guidelinerecommended process. In addition, accelerating factors perceived by care providers were identified. Methods: In this multiple case study, interviews with STEMI care providers were conducted, transcribed and used to create process descriptions per centre. Analyses consisted of within-case and between-case analyses of the processes. Accelerating factors were identified by means of open and axial coding. Results: In total, 28 interviews were conducted in six PCI centres. The centres differed from the guidelinerecommended process on, for example, additional, unavoidable patient routings and monitoring delays, and from one another on the communication of diagnostic information (eg, transmitting all, only ambiguous or no ECGs) and catheterisation room preparation. These differences indicated diverging choices to maintain a balance between speed and diagnostic accuracy. Factors perceived by care providers as accelerating the process included trust in the tentative diagnosis, and avoiding unnecessary intercaregiver consultations. The combination of processes and accelerating factors were summarised in a model. Conclusions: Numerous differences in processes between PCI centres were identified. Several timesaving strategies were applied by PCI centres, however, in different configurations. To further improve the care for patients with STEMI, best practices can be shared between centres and countries.
AB - Background: Rapid reperfusion with percutaneous coronary intervention (PCI) is vital for patients with ST segment elevation myocardial infarction (STEMI). However, the guideline-recommended time targets are regularly exceeded. The goal of this study was to gain insight into how Dutch PCI centres try to achieve these time targets by comparing their care processes with one another and with the European guidelinerecommended process. In addition, accelerating factors perceived by care providers were identified. Methods: In this multiple case study, interviews with STEMI care providers were conducted, transcribed and used to create process descriptions per centre. Analyses consisted of within-case and between-case analyses of the processes. Accelerating factors were identified by means of open and axial coding. Results: In total, 28 interviews were conducted in six PCI centres. The centres differed from the guidelinerecommended process on, for example, additional, unavoidable patient routings and monitoring delays, and from one another on the communication of diagnostic information (eg, transmitting all, only ambiguous or no ECGs) and catheterisation room preparation. These differences indicated diverging choices to maintain a balance between speed and diagnostic accuracy. Factors perceived by care providers as accelerating the process included trust in the tentative diagnosis, and avoiding unnecessary intercaregiver consultations. The combination of processes and accelerating factors were summarised in a model. Conclusions: Numerous differences in processes between PCI centres were identified. Several timesaving strategies were applied by PCI centres, however, in different configurations. To further improve the care for patients with STEMI, best practices can be shared between centres and countries.
UR - http://www.scopus.com/inward/record.url?scp=85011286663&partnerID=8YFLogxK
U2 - https://doi.org/10.1136/openhrt-2016-000458
DO - https://doi.org/10.1136/openhrt-2016-000458
M3 - Article
C2 - 28890792
SN - 2053-3624
VL - 4
JO - Open Heart
JF - Open Heart
IS - 1
M1 - e000458
ER -