None listed
Conditions
Brief summary
Background People living in rural Australia are more likely to die in hospital following an acute myocardial infarction (AMI i.e. “heart attack”) than people in major cities (Moon & Phillips 2007). This disparity is partly due to lower uptake of National Heart Foundation (NHF) guidelines for the administration of thrombolytic drugs. One-third of eligible patients in rural areas do not receive this life-saving intervention (Kinsman et al. 2007). Clinical pathways are structured, locally developed multidisciplinary care plans for specific clinical problems that take into account local resources and availability of doctors. They are an important tool for linking evidence to practice and can enhance adherence to guidelines for use of thrombolytic drugs (Campbell et al.1998). Given that outcomes after AMI in rural settings are poor and that clinical pathways can improve outcomes this study trialled an evidence-based clinical pathway implementation process and its impact on AMI treatment in rural hospitals. Participants Six Victorian rural hospitals participated. Pairs of hospitals were matched according to the anticipated number of eligible patients and randomly allocated to either the intervention (n=3) or control (n=3) sites. Method The intervention sites participated in a 6 month implementation process. The 5 step evidence-based intervention involved: (1) Engaging clinicians, (2) Clinical pathway development, (3) Reminders, (4) Education, and (5) Audit and feedback. The control group received hard copies of the relevant NHF guidelines. Medical records of all patients diagnosed with AMI attending the 6 hospitals during the study period were identified using International Statistical Classification of Diseases (ICD-10) codes. The records were then audited using a standardised data protocol (approximate total of 600 records across 6 sites). Data included type of AMI, gender, and age. The audit also checked whether criteria for use of a thrombolytic drug were met, and if so, whether one was administered and the time in minutes from presentation to administration. Results The implementation of the clinical pathway had no impact on process measures. Conclusion Interventions to narrow the evidence-practice gap for the management of chest pain in rural settings require further evaluation if the gap in outcomes between rural and urban settings is to be reduced.
Interventions
A five step process over 3 months of implementing clinical pathways for AMI management in rural emergency departments.
The intervention sites will participate in the 5 step evidence-based implementation process described below. The control group will receive a hard copy of the relevant NHF guidelines. The evidence-based 5 step intervention within emergency departments to implement clinical pathways will be a combination of processes proposed by Doherty and Jones (2006) and Kinsman et al. (2007).
A five step process over 3 months of implementing clinical pathways for AMI management in rural emergency departments. The intervention sites will participate in the 5 step evidence-based implementation process described below. The control group will receive a hard copy of the relevant NHF guidelines. The evidence-based 5 step intervention within emergency departments to implement clinical pathways will be a combination of processes proposed by Doherty and Jones (2006) and Kinsman et al. (2007). In brief, the three month implementation process involves: (b) Engaging clinicians Group discussions will be held with medical and nursing staff regarding barriers and facilitators for clinical pathways whilst local clinicians will be recruited as Research Assistants. This role will involve activities such as participating in the clinical pathway development, as described below, and promoting the study amongst other staff members. (c) Clinical pathway development Hospital-specific clinical pathways will be developed collaboratively at each emergency department. (d) Reminders Reminder visits will occur twice following implementation to liaise with staff. Research Assistants will also be asked to remind medical and nursing staff about the clinical pathway. (e) Education Education sessions will be held during implementation to review evidence underpinning the clinical pathway. All staff will receive written material regarding thrombolytic drugs. (f) Audit and feedback Audit results reflecting compliance with the clinical pathway and thrombolysis administration will be communicated to staff twice during the implementation of the clinical pathway.
Sponsors
Faculty of Medicine, Nursing and Health Sciences
Study design
Allocation
Randomised controlled trial
Intervention model
Single group
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
AMI patients meeting criteria for delivery of thrombolytic drugs.
Exclusion criteria
AMI not primary diagnosis.
Outcome results
None listed