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UBC Theses and Dissertations
Critical path management for acute myocardial infarction Lo, Angela B. K.
Abstract
Atherosclerotic coronary artery disease continues to be the major underlying cause of myocardial infarction and the leading cause of death in Western society. Preliminary data from a number of Canadian hospitals on the treatment of acute myocardial infarction (AMI) indicate a significant gap between knowledge of proven efficacious therapies and their clinical application. This was a prospective study, with retrospective controls, of 592 AMI patients at Royal Columbian Hospital and Surrey Memorial Hospital, to determine the efficacy of a critical path for management of AMI patients. Critical path, a continuous quality improvement (CQI) tool, involves the development and implementation of pre-printed standard orders for all AMI patients. The critical path for AMI management was created based on benchmark clinical trials. The objective was to increase the utilization of betablockers, and ASA, both proven efficacious therapies. Other outcomes of interest include assessments of in-hospital mortality, length of hospital stay, and use of thrombolytics. The primary endpoints were changes in usage of ASA and betablocker after the critical path protocol. The increase in use of ASA was 1.89% (p=0.511) and in the use of beta-blocker was 4.85% (p=0.381). Secondary endpoints of in-hospital mortality and length of hospital stay demonstrated a non-significant decrease for inhospital mortality, and a 0.98 day increase in length of hospital stay. In addition, the critical path protocol led to a 2.22% increase in usage for thrornbolytics, another proven efficacious therapy, and a 13.3% decrease for calcium channel blockers, and 20.8% decrease for anti-arrhythmics, both unproven and possibly harmful medications for treatment of AMI. Implementation of the critical path protocol can be a valuable tool in maintaining the utilization of proven efficacious therapies and dissemination of medical knowledge.
Item Metadata
| Title |
Critical path management for acute myocardial infarction
|
| Creator | |
| Publisher |
University of British Columbia
|
| Date Issued |
1995
|
| Description |
Atherosclerotic coronary artery disease continues to be the
major underlying cause of myocardial infarction and the leading
cause of death in Western society. Preliminary data from a number
of Canadian hospitals on the treatment of acute myocardial
infarction (AMI) indicate a significant gap between knowledge of
proven efficacious therapies and their clinical application.
This was a prospective study, with retrospective controls, of
592 AMI patients at Royal Columbian Hospital and Surrey Memorial
Hospital, to determine the efficacy of a critical path for
management of AMI patients. Critical path, a continuous quality
improvement (CQI) tool, involves the development and implementation
of pre-printed standard orders for all AMI patients. The critical
path for AMI management was created based on benchmark clinical
trials. The objective was to increase the utilization of betablockers,
and ASA, both proven efficacious therapies. Other
outcomes of interest include assessments of in-hospital mortality,
length of hospital stay, and use of thrombolytics.
The primary endpoints were changes in usage of ASA and betablocker
after the critical path protocol. The increase in use of
ASA was 1.89% (p=0.511) and in the use of beta-blocker was 4.85%
(p=0.381). Secondary endpoints of in-hospital mortality and length
of hospital stay demonstrated a non-significant decrease for inhospital
mortality, and a 0.98 day increase in length of hospital
stay. In addition, the critical path protocol led to a 2.22%
increase in usage for thrornbolytics, another proven efficacious
therapy, and a 13.3% decrease for calcium channel blockers, and
20.8% decrease for anti-arrhythmics, both unproven and possibly
harmful medications for treatment of AMI.
Implementation of the critical path protocol can be a valuable
tool in maintaining the utilization of proven efficacious therapies
and dissemination of medical knowledge.
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| Extent |
3740899 bytes
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| Genre | |
| Type | |
| File Format |
application/pdf
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| Language |
eng
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| Date Available |
2009-01-17
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| Provider |
Vancouver : University of British Columbia Library
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| Rights |
For non-commercial purposes only, such as research, private study and education. Additional conditions apply, see Terms of Use https://open.library.ubc.ca/terms_of_use.
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| DOI |
10.14288/1.0086782
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| URI | |
| Degree | |
| Program | |
| Affiliation | |
| Degree Grantor |
University of British Columbia
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| Graduation Date |
1995-05
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| Campus | |
| Scholarly Level |
Graduate
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| Aggregated Source Repository |
DSpace
|
Item Media
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Rights
For non-commercial purposes only, such as research, private study and education. Additional conditions apply, see Terms of Use https://open.library.ubc.ca/terms_of_use.