American Heart Journal
Volume 152, Issue 4 , Pages 648-660, October 2006

The impact of emergency department structure and care processes in delivering care for non–ST-segment elevation acute coronary syndromes

  • Rajendra H. Mehta, MD, MS

      Affiliations

    • Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
    • ,
  • L. Kristin Newby, MD, MHS

      Affiliations

    • Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
    • Corresponding Author InformationCorrespondence: L. Kristin Newby, MD, MHS, PO Box 17969, Durham, NC 27715-7969.
    • ,
  • Yogin Patel, MD, MBA

      Affiliations

    • Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
    • ,
  • James W. Hoekstra, MD

      Affiliations

    • Wake Forest University Health Sciences, Winston-Salem, NC
    • ,
  • Chadwick D. Miller, MD

      Affiliations

    • Wake Forest University Health Sciences, Winston-Salem, NC
    • ,
  • Anita Y. Chen, MS

      Affiliations

    • Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
    • ,
  • Barbara L. Lytle, MS

      Affiliations

    • Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
    • ,
  • Deborah B. Diercks, MD

      Affiliations

    • University of California Davis Medical Center, Sacramento, CA
    • ,
  • Richard L. Summers, MD

      Affiliations

    • University of Mississippi Medical Center, Jackson, MS
    • ,
  • Gerard X. Brogan, MD

      Affiliations

    • North Shore LIJ Health System, Plainview, NY
    • ,
  • W. Frank Peacock, MD

      Affiliations

    • Cleveland Clinic Foundation, Cleveland, OH
    • ,
  • Charles V. Pollack Jr, MD, MA

      Affiliations

    • University of Pennsylvania School of Medicine, Pennsylvania Hospital, Philadelphia, PA
    • ,
  • Matthew T. Roe, MD, MHS

      Affiliations

    • Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
    • ,
  • Eric D. Peterson, MD, MPH

      Affiliations

    • Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
    • ,
  • E. Magnus Ohman, MD

      Affiliations

    • University of North Carolina School of Medicine, Chapel Hill, NC
    • ,
  • W. Brian Gibler, MD

      Affiliations

    • University of Cincinnati School of Medicine, Cincinnati, OH
    • ,
  • for the CRUSADE Investigators

Received 20 December 2005; accepted 10 April 2006. published online 04 July 2006.

Background

We sought to assess the influence of emergency department (ED) structure and care processes on adherence to practice guidelines for the treatment of patients with non–ST-segment elevation acute coronary syndromes.

Methods

We surveyed emergency physicians and nurses from 316 hospitals participating in the CRUSADE Quality Improvement Initiative and used multivariable modeling to correlate ED-specific characteristics with guidelines adherence.

Results

Factors that were significantly associated with improved guidelines adherence included collaboration between emergency physicians and hospital administration, northeast region, adequate nursing support, use of locum tenens physicians, an independent ED (not a division of another clinical department), and use of a care algorithm for acute coronary syndromes.

Conclusions

Quality improvement strategies that have the full support of hospital administration, focus on increasing collaboration between emergency physicians and other health care providers, and specified protocol-driven management algorithm may be the most successful methods for improving the care and outcomes of patients with non–ST-segment elevation acute coronary syndromes.

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 CRUSADE is funded by the Schering-Plough Corporation, Kenilworth, NJ. Bristol-Myers Squibb/Sanofi-Aventis Pharmaceuticals Partnership, New York, NY and Paris, France, provides additional funding support. Millennium Pharmaceuticals, Inc, Cambridge, MA also provided funding for this work.

PII: S0002-8703(06)00344-9

doi:10.1016/j.ahj.2006.04.015

American Heart Journal
Volume 152, Issue 4 , Pages 648-660, October 2006

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