Introduction
Methods
Patient data
Quality indicator definitions
A.
| |
Definition
| Percentage of patients diagnosed with STEMI treated with PCI within 90 min of first medical/paramedical contact. we prefer to keep to the correct definition |
Numerator
| All patients undergoing PCI treatment within 90 min of first medical/paramedical contact. Medical/paramedical contact is defined as the general practitioner, emergency medical services or emergency department. PCI treatment is defined as the time of sheath insertion |
Denominator
| All patients diagnosed with STEMI |
Inclusion
| All patients diagnosed with STEMI |
Exclusion
| Patients with unstable angina or NSTEMI |
B.
| |
Definition
| Percentage of patients diagnosed with STEMI treated with primary PCI within 90 min of first ECG |
Numerator
| All patients diagnosed with STEMI treated with primary PCI within 90 min of first ECG. If patients developed a STEMI while being hospitalised for another illness or symptom, the time of the first ECG with ST-segment elevation in hospital was registered. Start of PCI is defined as the time of sheath insertion |
Denominator
| All patients diagnosed with STEMI treated with primary PCI |
Inclusion
| All patients with the diagnosis treatment combination code for ACS and discharge diagnosis of STEMI |
Exclusion
| STEMI patients undergoing pharmacological treatment or non-acute PCI (i.e. documented sub-acute or old infarction, ST-segment resolution on the electrocardiogram in combination with the absence of symptoms on admission); STEMI patients with > 6 h between ECG and PCI; patients with a secondary infarction (e.g. due to anaemia) |
C.
| |
Definition
| Mean door-to-needle time
Note: no threshold provided
|
D.
| |
Definition 1
| Median time from hospital arrival to PCI in AMI patients with ST-segment elevation or LBBB on the ECG performed closest to hospital arrival time |
Definition 2
| AMI patients with ST-segment elevation or LBBB on the ECG closest to arrival time receiving primary PCI during the hospital stay with a time from hospital arrival to PCI of 90 min or less |
Numerator
| AMI patients whose time from hospital arrival to primary PCI is 90 min or less |
Denominator
| AMI patients with ST-segment elevation or LBBB on ECG who received primary PCI |
Inclusion
| Discharges with: An ICD-9-CM Principal Diagnosis Code for AMI AND PCI (ICD-9-CM Principal or Other Procedure Codes for PCI) AND ST-segment elevation or LBBB on the ECG performed closest to hospital arrival AND PCI performed within 24 h after hospital arrival |
Exclusion
| Patients less than 18 years of age Patients received in transfer from the inpatient, outpatient, or emergency department of another facility Patients given a fibrinolytic agent prior to PCI PCI described as non-primary by a physician/APN/PA Patients who did not receive PCI within 90 min and had a reason for delay documented by a physician, APN/PA (e.g. social, religious, initial concern or refusal, cardiopulmonary arrest, balloon pump insertion, respiratory failure requiring intubation) |
E.
| |
Description
| …a target for quality assessment is that primary PCI (wire passage) should be performed within 90 min after FMC in all cases. In patients presenting early, with a large amount of myocardium at risk, the delay should be shorter (60 min). In patients presenting directly to a PCI-capable hospital, the goal should also be to achieve primary PCI within 60 min of FMC. Although no specific studies have been performed, a maximum delay of only 90 min after FMC seems a reasonable goal in these patients. Note that these target delays for implementation of primary PCI are quality indicators and that they differ from the maximal PCI-related delay of 120 min, which is useful in selecting primary PCI over immediate thrombolysis as the preferred mode of reperfusion |
Outcome measures
Data quality
Influence of definitions on indicator scores
Results
Patient data
Outcome measures
Data quality
1 | 2 | 3 | 4 | 5 | 6 | 7 | |
---|---|---|---|---|---|---|---|
First contact | Care pathway registration/patient record (paper) | HIS | HIS | Scanned in HIS/ cardiology department database | Care pathway registration/patient record (paper)/report in HIS | HIS | Patient record (paper) |
ECG | Patient record (paper) | Scanned in HIS/cathlab system | Scanned in HIS | Scanned in HIS/cardiology department database | Patient record (paper)/scanned in HIS/care pathway registration | Scanned in separate folder on hard disk | Patient record (paper)/cathlab system |
Arrival PCI centre | Patient record (paper) | HIS | HIS | HIS/cardiology department database | Admission system | Separate database | Patient record (paper)/HIS |
Sheath insertion | Cathlab report | Separate cathlab system | HIS | Cathlab report in HIS, or cardiology department database | Cathlab report/care pathway registration | Cathlab report in HIS | Cathlab system |
First intervention | Cathlab report | Not available | HIS | Cardiology department database | Care pathway registration | Cathlab system | Cathlab system |
Influence of definition on indicator scores
Hospital (number) | 1 | 2 | 3 | 4 | 5 | 6 | 7 | Total (patient with missing data % and indicator reached n) |
---|---|---|---|---|---|---|---|---|
Definition of treatment delay | ||||||||
A. Dutch ‘VMS safety management program’ guideline | 82 %
13; 23
| 93 % n/a | 86 % 10; 16 | 44 % 36; 63 | 69 % 40; 56 | 99 % n/a | 71 % 49; 69 | 85 % 156; 236 |
B. Adjusted Dutch ‘VMS safety management program’ guideline | 36 % 81; 104 | 15 % 102; 117 | 23 % 86; 107 | 38 % 69; 109 | 30 % 119; 136 | 50 % 70; 98 | 30 % 165; 207 | 32 % 692; 878 |
C.a
Mean door-to-needle time (IGZ) |
91 %
11
(n = 98)
|
85 %
18
(n = 106)
|
100 %
n/a
(–)
|
87 %
9
(n = 15)
|
86 %
24
(n = 137)
|
83 %
23
(n = 131)
|
93 %
17
(n = 22)
|
50 %
19
(n = 509)
|
D. Door-to-balloon time (ACC/AHA) | 24 % 97; 98 | 100 % n/a | 100 % n/a | 86 % 16; 16 | 21 % 135; 136 | 100 % n/a | 91 % 21; 22 | 74 % 269; 272 |
Total (
n
of patients)
| 127 | 120 | 112 | 112 | 171 | 139 | 236 | 1017 |