PMID- 31259283
OWN - NLM
STAT- MEDLINE
DCOM- 20200608
LR  - 20200608
IS  - 2399-6641 (Electronic)
IS  - 2399-6641 (Linking)
VI  - 8
IP  - 2
DP  - 2019
TI  - Improving the prehospital management of ST elevation myocardial infarction: a 
      national quality improvement initiative.
PG  - e000508
LID - 10.1136/bmjoq-2018-000508 [doi]
LID - e000508
AB  - ST elevation myocardial infarction (STEMI) is a time-dependent clinical 
      emergency. Early recognition and intervention in the clinical course of STEMI are 
      key to reducing mortality and morbidity. As a result, the benefits of the 
      prehospital management of patients presenting with STEMI are well supported by 
      the literature. Given these benefits, much of the focus on the development of 
      quality and performance measures for Emergency Medical Services has focused on 
      STEMI care. Historically, within Qatar, however, no measures of prehospital STEMI 
      care have previously existed and as such, little is understood regarding the 
      quality of prehospital care delivered to patients with STEMI. The overall aim of 
      this national initiative was to improve the effectiveness of the prehospital care 
      of patients with STEMI, to a minimum compliance of 75%, as measured by four 
      process measures and one bundle measure, over a 12-month period. Initial efforts 
      were aimed at the development of relevant indicators to guide assessment and 
      identifying an appropriate patient cohort to test improvement efforts. Using 
      these measures and criteria, the project team highlighted several areas for 
      potential improvement centred on three key domains within the service: clinical 
      practice, training and clinical equipment/medication. There was significant and 
      sustained improvement across all measures recorded. For the bundle measure, the 
      median proportional compliance increased from 39% pre-improvement activities to 
      76% post-improvement activities and remained sustained at 12 months 
      post-implementation. The initiative was successful in meeting all of its aims and 
      furthermore showed sustained compliance at 12 months post-implementation, thanks 
      in part to what were designed to be changes that were simple, yet pragmatic, and 
      readily producible at scale. While a formal cost analysis was not conducted, the 
      improvement activities capitalised on existing organisational structures and 
      processes with the resultant cost perceived to be negligible.
FAU - Howard, Ian
AU  - Howard I
AD  - Critical Care Services, Hamad Medical Corporation Ambulance Service, Doha, Qatar.
FAU - Castle, Nicholas
AU  - Castle N
AD  - Critical Care Services, Hamad Medical Corporation Ambulance Service, Doha, Qatar.
FAU - Al Shaikh, Loua
AU  - Al Shaikh L
AD  - Critical Care Services, Hamad Medical Corporation Ambulance Service, Doha, Qatar.
FAU - Owen, Robert
AU  - Owen R
AD  - Critical Care Services, Hamad Medical Corporation Ambulance Service, Doha, Qatar.
LA  - eng
PT  - Journal Article
DEP - 20190602
PL  - England
TA  - BMJ Open Qual
JT  - BMJ open quality
JID - 101710381
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Vasodilator Agents)
RN  - A74586SNO7 (Clopidogrel)
RN  - G59M7S0WS3 (Nitroglycerin)
RN  - R16CO5Y76E (Aspirin)
MH  - Aspirin/administration & dosage/therapeutic use
MH  - Clopidogrel/administration & dosage/therapeutic use
MH  - Electrocardiography/methods/statistics & numerical data
MH  - Emergency Medical Services/methods/*standards/statistics & numerical data
MH  - Guideline Adherence/standards
MH  - Humans
MH  - Nitroglycerin/administration & dosage/therapeutic use
MH  - Platelet Aggregation Inhibitors/administration & dosage/therapeutic use
MH  - Qatar
MH  - Quality Improvement
MH  - Quality Indicators, Health Care/statistics & numerical data
MH  - ST Elevation Myocardial Infarction/diagnosis/*therapy
MH  - Vasodilator Agents/administration & dosage/therapeutic use
PMC - PMC6567945
OTO - NOTNLM
OT  - performance measures
OT  - prehospital care
OT  - quality improvement
COIS- Competing interests: None declared.
EDAT- 2019/07/02 06:00
MHDA- 2019/07/02 06:01
PMCR- 2019/06/02
CRDT- 2019/07/02 06:00
PHST- 2018/08/20 00:00 [received]
PHST- 2018/11/20 00:00 [revised]
PHST- 2018/11/20 00:00 [accepted]
PHST- 2019/07/02 06:00 [entrez]
PHST- 2019/07/02 06:00 [pubmed]
PHST- 2019/07/02 06:01 [medline]
PHST- 2019/06/02 00:00 [pmc-release]
AID - bmjoq-2018-000508 [pii]
AID - 10.1136/bmjoq-2018-000508 [doi]
PST - epublish
SO  - BMJ Open Qual. 2019 Jun 2;8(2):e000508. doi: 10.1136/bmjoq-2018-000508. 
      eCollection 2019.