Reduction of door-to-needle time in the management of patients with acute myocardial infarction admitted to the coronary care unit in District General Hospital Matara Sri Lanka

Abstract

<strong>Introduction:</strong> Acute myocardial infarction (MI) is the leading cause of death in Sri Lanka. The American College of Chest Physicians (ACCP) guidelines recommend that for patients with acute MI who are candidates for fibrinolytic therapy, the therapy should be administered within 30 min of arrival at the hospital or first contact with the healthcare system (grade 1A). <strong>Objective:</strong> To reduce door-to-needle time to 30 minutes in the management of patients with ST elevated myocardial infarction (STEMI) admitted to the coronary care unit in District General Hospital (DGH) Matara. <strong>Methodology:</strong> A clinical audit was done by analyzing the prevailing process of thrombolysis for acute MI. Based on the identified gaps an integrated care pathway (ICP) was introduced as an intervention. This included the removal of irrelevant steps, avoiding unnecessary delays, and assigning a responsible person to each step in the process. A comparison was done between pre and post-interventional groups. <strong>Results:</strong> Door-to-needle time was significantly shorter after the introduction of ICP (intervention). <strong>Conclusion:</strong> ICP is a good tool for quality assurance. It was helpful in reducing the door-to-needle time in the management of patients with STEMI admitted to the cardiac care unit in DGH Matara, once it was used as the intervention in clinical audit.