Critical path management for acute myocardial infarction

Atherosclerotic coronary artery disease continues to be the major underlying cause of myocardial infarction and the leading cause of death in Western society. Preliminary data from a number of Canadian hospitals on the treatment of acute myocardial infarction (AMI) indicate a significant gap between knowledge of proven efficacious therapies and their clinical application. This was a prospective study, with retrospective controls, of 592 AMI patients at Royal Columbian Hospital and Surrey Memorial Hospital, to determine the efficacy of a critical path for management of AMI patients. Critical path, a continuous quality improvement (CQI) tool, involves the development and implementation of pre-printed standard orders for all AMI patients. The critical path for AMI management was created based on benchmark clinical trials. The objective was to increase the utilization of betablockers, and ASA, both proven efficacious therapies. Other outcomes of interest include assessments of in-hospital mortality, length of hospital stay, and use of thrombolytics. The primary endpoints were changes in usage of ASA and betablocker after the critical path protocol. The increase in use of ASA was 1.89% (p=0.511) and in the use of beta-blocker was 4.85% (p=0.381). Secondary endpoints of in-hospital mortality and length of hospital stay demonstrated a non-significant decrease for inhospital mortality, and a 0.98 day increase in length of hospital stay. In addition, the critical path protocol led to a 2.22% increase in usage for thrornbolytics, another proven efficacious therapy, and a 13.3% decrease for calcium channel blockers, and 20.8% decrease for anti-arrhythmics, both unproven and possibly harmful medications for treatment of AMI. Implementation of the critical path protocol can be a valuable tool in maintaining the utilization of proven efficacious therapies and dissemination of medical knowledge.Pharmaceutical Sciences, Faculty ofGraduat