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Improving care for acute myocardial infarction
The acute myocardial infarction intervention uses some of the concepts of ‘bundle’ care but not all aspects are mandatory, they are implemented depending on individual patient conditions (for example, smoking cessation and ACE-inhibitors for systolic dysfunction).
Should the time-frame for receipt of Aspirin on the admission audit tool for both STEMI and non-STEMI be “within 30 minutes” of arrival?
The toolkit states that the patient should receive an antiplatelet agent "before, or within 24 hours of admission". The term 'before' is an indication of the intended optimal time. Twenty-four hours is mentioned as a cut off time for the sake of the audit.
Can patients diagnosed with unstable angina be included in the audits for non-STEMI?
The Heart Foundation’s 'Management of Unstable Angina Guideline - 2000' identifies the distinction between unstable angina and non-STEMI as being 'cloudy' and the diagnoses of unstable angina, minor myocardial damage and non-STEMI representing a continuum1.
At the time of admission, it is likely that patients with unstable angina will receive the same care as patients with non-STEMI, and may continue to receive the same level of care throughout their stay. The point really is about the care that is received. If a patient diagnosed with unstable angina is receiving care as per the bundle, by all means audit accordingly.
Our hospital is often required to send patients to another hospital for treatment. If this occurs, for example, with an AMI patient, how is the patient represented in our data collection?
If possible exclude these patients from the audit. If it is not possible to exclude them because the sample size would be adversely affected, you can demonstrate compliance in care for the period the patient is at your hospital. If the patient receives all the components for STEMI admission, then is transferred, you should consider this patient to be compliant. The same will be true for the receiving hospital, if the patient arrives after receiving the admission components at your facility, then the receiving hospital will concentrate on demonstrating compliance with during hospitalisation and discharge care.
The compliance measure for AMI implies that all patients need to be included. We are concerned that this is a large undertaking, especially as the other interventions are only required to collect data on up to 20 patients. Can you comment on this?
In the interests of consistency, the AMI compliance measure can be limited to a sample of ‘up to 20 patients’ as for the other interventions (apart from RRS).
The compliance measure will be understood as:
The sample will be the number of patients audited.
Last updated: 15 June, 2007
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