The Effect of Guality Improvement Program on In-Hospital Acute Myocardial Infarction Care in Afshar Hospital(Yazd-2004)

AMI is a major coronary disease that causes a high degree of death and disability. Worldwide death rate from AMI is declining and a significant cause of this decline is due to diagnosis and treatment. However, results indicate that many patients are deprived of proper treatment. In the present study AMI quality improvement program in Yazd Afshar Hospital was implemented to improve the quality of in-hospital AMI care. Patients & This study had 3 stages: 1- baseline assessment, 2-feedback and intervention and 3-remeasurement. To quantify baseline situation, 143 AMI patients who were admitted to Afshar Hospital during one year(2003) were studied. Later, a group discussion and baseline results feedback were arranged and then the group selected an educational plan to improve the quality. Booklets and posters were prepared based on hospital AMI guidelines and then distributed. After intervention, AMI patients admitted to hospital were assessed for 4 months(during 2004) again. In baseline assessment, aspirin and b-blocker administration at admission for eligible patients was 86.1% and 79% respectively. Among patients who received thrombolytic, only 50.5% received it in less than 30 minutes from hospital arrival and mean time to thrombolysis was 44.38 minutes. No patient during hospital stay took advice/counseling for smoke cessation and echocardiography was performed for 44.3% of patients. Aspirin and b-blocker in discharge were administred for 41.9% and 36.6% eligible patients respectively and 20% of heart failure patients were administerd ACE(inh) at discharge. In-hospital deaths were a little more than expected(relative hospital mortality=1.12). Remeasuring and comparing the results showed significant improvements in smoke cessation advice/counseling, performing echocardiography during hospital stay and in administration of aspirin, b-blocker, and ACE(inh) at discharge. Improvement caused by aspirin and b-blocker at hospital admission was not statistically significant. There are many opportunities for care improvement in this hospital and quality improvement program can be effective. In short, continuation and development of this program in Afshar Hospital and the initiation of such programs in other hospitals are suggested.