The impact of emergency department structure and care processes in delivering care for non–ST-segment elevation acute coronary syndromes
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.
aDuke Clinical Research Institute, Duke University Medical Center, Durham, NC
bWake Forest University Health Sciences, Winston-Salem, NC
cUniversity of California Davis Medical Center, Sacramento, CA
dUniversity of Mississippi Medical Center, Jackson, MS
gUniversity of Pennsylvania School of Medicine, Pennsylvania Hospital, Philadelphia, PA
hUniversity of North Carolina School of Medicine, Chapel Hill, NC
iUniversity of Cincinnati School of Medicine, Cincinnati, OH
Correspondence: L. Kristin Newby, MD, MHS, PO Box 17969, Durham, NC 27715-7969.
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.
ABSTRACT