Larson David M, Sharkey Scott W, Unger Barbara T, Henry Timothy D
Department of Emergency Medicine, Ridgeview Medical Center, Waconia, MN, USA.
Acad Emerg Med. 2005 Jun;12(6):522-7. doi: 10.1197/j.aem.2005.01.008.
To obtain information regarding the current use of guidelines and protocols and quality assessment practices for the management of ST-segment elevation myocardial infarction in Minnesota hospitals without cardiac catheterization laboratories.
Structured surveys were mailed in 2003 to emergency department medical directors or nurse managers in 111 hospitals in Minnesota that did not have cardiac catheterization laboratories. Of the 111 hospitals surveyed, 104 (94%) responded.
Sixty-three percent of responding hospitals have guidelines or protocols; 57% use standing orders for ST-segment elevation myocardial infarction. Thirty-three percent have neither. Of those with guidelines, protocols, or standing orders, 8% address triage and transfer criteria, 86% thrombolytics, 91% aspirin, and 71% beta-blockers. Fifty percent have quality assessment processes in place for ST-segment elevation myocardial infarction.
Recommendations from the National Heart Attack Alert Program issued more than ten years ago and, more recently, the updated American College of Cardiology/American Heart Association Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction suggest development of emergency department and hospital-specific guidelines and protocols for ST-segment elevation myocardial infarction. Currently, only two thirds of community hospitals in Minnesota have these in place; when present, these guidelines are often incomplete and rarely address transfer criteria to hospitals with percutaneous coronary intervention capability. Quality assessment occurred in 50% of hospitals surveyed. Programs to help community hospitals develop and implement guidelines and quality improvement should be encouraged and supported.
获取明尼苏达州没有心导管实验室的医院在ST段抬高型心肌梗死管理方面当前使用指南和方案以及质量评估实践的相关信息。
2003年向明尼苏达州111家没有心导管实验室的医院的急诊科医疗主任或护士长邮寄了结构化调查问卷。在接受调查的111家医院中，104家（94%）做出了回应。
63%的回应医院有指南或方案；57%对ST段抬高型心肌梗死使用常规医嘱。33%既没有指南也没有方案。在有指南、方案或常规医嘱的医院中，8%涉及分诊和转运标准，86%涉及溶栓药物，91%涉及阿司匹林，71%涉及β受体阻滞剂。50%的医院对ST段抬高型心肌梗死有质量评估流程。
十多年前发布的国家心脏病发作警报计划的建议，以及最近更新的美国心脏病学会/美国心脏协会ST段抬高型心肌梗死患者管理指南，都建议制定急诊科和医院特定的ST段抬高型心肌梗死指南和方案。目前，明尼苏达州只有三分之二的社区医院具备这些；即便有这些指南，也往往不完整，很少涉及转至具备经皮冠状动脉介入能力医院的标准。50%接受调查的医院进行了质量评估。应鼓励和支持帮助社区医院制定和实施指南及质量改进的项目。
