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dc.contributor.authorGuidry, Ursula A.en_US
dc.contributor.authorPaul, Sumita D.en_US
dc.contributor.authorVega, Joseen_US
dc.contributor.authorHarris, Cathieen_US
dc.contributor.authorChaturvedi, Rahulen_US
dc.contributor.authorO'Gara, Patrick T.en_US
dc.contributor.authorEagle, Kim A.en_US
dc.date.accessioned2006-09-11T19:41:14Z
dc.date.available2006-09-11T19:41:14Z
dc.date.issued1998-01en_US
dc.identifier.citationGuidry, Ursula A.; Paul, Sumita D.; Vega, Jose; Harris, Cathie; Chaturvedi, Rahul; O'Gara, Patrick T.; Eagle, Kim A.; (1998). "Impact of a Simple Inexpensive Quality Assurance Effort on Physician's Choice of Thrombolytic Agents and Door-to-Needle Time: Implication for Costs of Management." Journal of Thrombosis and Thrombolysis 5(2): 151-157. <http://hdl.handle.net/2027.42/48037>en_US
dc.identifier.issn0929-5305en_US
dc.identifier.issn1573-742Xen_US
dc.identifier.urihttps://hdl.handle.net/2027.42/48037
dc.identifier.urihttp://www.ncbi.nlm.nih.gov/sites/entrez?cmd=retrieve&db=pubmed&list_uids=10767110&dopt=citationen_US
dc.description.abstractThe objective of this study were to assess the impact of a quality assurance effort on the door-to-needle time and the choice of thrombolytic agent for the management of acute myocardial infarction in the emergency department. The study design involved a prospective collection of data on a series of consecutive patients who received a thrombolytic agent for a presumed acute myocardial infarction. The study was carried out in the emergency department of a major university urban tertiary care center. A total of 349 patients were studied from September 1989 to March 1994. The quality assurance program began in 1989 and included chart review of all patients receiving thrombolytic therapy, with special attention to all patients with door-to-needle times >60 minutes to identify causes for delay. Feedback was directed to pharmacy, nursing, and physician staff. Biannual reports were distributed throughout the hospital and the emergency department. Nursing-specific feedback led to the development of protocols for all aspects of the delivery of thrombolytic agents. The choice of thrombolytic agent was not dictated by the protocol, but the physician staff was continuously updated on the results of the latest clinical trials comparing one thrombolytic agent with another. The mean age was 58 years for men and 67 years for women in this cohort consisting of 78% men and 22% women. Thirty-seven percent of the myocardial infarctions were in an anterior location and 56% were in an inferior location. The median duration of chest pain before presentation to the emergency department was 120 minutes. Hospital mortality was 3%. Median door-to-needle time fell from 46 (1989–1991) to 36 (1992–1994) minutes, P < 0.01. The percentage of patients with a door-to-needle time >60 minutes decreased from 35% (1989–1991) to 16% (1992–1994) minutes, P < 0.0001. Corresponding with the ISIS-3 report, there was a significant increase in the proportion of patients receiving streptokinase over the first 3 years of the study (P < 0.0001), which changed to a trend toward increased utilization of tissue plasminogen activator with the GUSTO report in the final 6 months of the study. In conclusion, a quality assurance program led to a significant reduction in the door-to-needle time, and recent megatrials were found to influence the choice of thrombolytic agent used.en_US
dc.format.extent89037 bytes
dc.format.extent3115 bytes
dc.format.mimetypeapplication/pdf
dc.format.mimetypetext/plain
dc.language.isoen_US
dc.publisherKluwer Academic Publishers; Springer Science+Business Mediaen_US
dc.subject.otherMedicine & Public Healthen_US
dc.subject.otherCardiologyen_US
dc.subject.otherHematologyen_US
dc.subject.otherThrombolytic Therapyen_US
dc.subject.otherTime Factorsen_US
dc.subject.otherQuality Assuranceen_US
dc.subject.otherMyocardial Infarctionen_US
dc.titleImpact of a Simple Inexpensive Quality Assurance Effort on Physician's Choice of Thrombolytic Agents and Door-to-Needle Time: Implication for Costs of Managementen_US
dc.typeArticleen_US
dc.subject.hlbsecondlevelMolecular, Cellular and Developmental Biologyen_US
dc.subject.hlbsecondlevelBiological Chemistryen_US
dc.subject.hlbsecondlevelOncology and Hematologyen_US
dc.subject.hlbtoplevelHealth Sciencesen_US
dc.subject.hlbtoplevelScienceen_US
dc.description.peerreviewedPeer Revieweden_US
dc.contributor.affiliationumCardiology Division, University of Michigan Medical Center, Ann Arbor, Michiganen_US
dc.contributor.affiliationotherCardiac Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusettsen_US
dc.contributor.affiliationotherCardiac Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusettsen_US
dc.contributor.affiliationotherCardiac Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusettsen_US
dc.contributor.affiliationotherCardiac Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusettsen_US
dc.contributor.affiliationotherCardiac Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusettsen_US
dc.contributor.affiliationotherCardiac Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusettsen_US
dc.contributor.affiliationumcampusAnn Arboren_US
dc.identifier.pmid10767110en_US
dc.description.bitstreamurlhttp://deepblue.lib.umich.edu/bitstream/2027.42/48037/1/11239_2004_Article_145367.pdfen_US
dc.identifier.doihttp://dx.doi.org/10.1023/A:1008834230015en_US
dc.identifier.sourceJournal of Thrombosis and Thrombolysisen_US
dc.owningcollnameInterdisciplinary and Peer-Reviewed


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