Tra Joppe, de Blok Carolien, van der Wulp Ineke, de Bruijne Martine C, Wagner Cordula
Department of Occupational and Public Health, EMGO+/VU University Medical Center, Amsterdam, The Netherlands.
Faculty of Economics and Business, Department of Operations, University of Groningen, Groningen, The Netherlands.
Open Heart. 2017 Jan 30;4(1):e000458. doi: 10.1136/openhrt-2016-000458. eCollection 2017.
Rapid reperfusion with percutaneous coronary intervention (PCI) is vital for patients with ST segment elevation myocardial infarction (STEMI). However, the guideline-recommended time targets are regularly exceeded. The goal of this study was to gain insight into how Dutch PCI centres try to achieve these time targets by comparing their care processes with one another and with the European guideline-recommended process. In addition, accelerating factors perceived by care providers were identified.
In this multiple case study, interviews with STEMI care providers were conducted, transcribed and used to create process descriptions per centre. Analyses consisted of within-case and between-case analyses of the processes. Accelerating factors were identified by means of open and axial coding.
In total, 28 interviews were conducted in six PCI centres. The centres differed from the guideline-recommended process on, for example, additional, unavoidable patient routings and monitoring delays, and from one another on the communication of diagnostic information (eg, transmitting all, only ambiguous or no ECGs) and catheterisation room preparation. These differences indicated diverging choices to maintain a balance between speed and diagnostic accuracy. Factors perceived by care providers as accelerating the process included trust in the tentative diagnosis, and avoiding unnecessary intercaregiver consultations. The combination of processes and accelerating factors were summarised in a model.
Numerous differences in processes between PCI centres were identified. Several time-saving strategies were applied by PCI centres, however, in different configurations. To further improve the care for patients with STEMI, best practices can be shared between centres and countries.
经皮冠状动脉介入治疗（PCI）快速再灌注对ST段抬高型心肌梗死（STEMI）患者至关重要。然而，经常超出指南推荐的时间目标。本研究的目的是通过比较荷兰PCI中心之间以及与欧洲指南推荐流程的护理过程，深入了解它们如何努力实现这些时间目标。此外，还确定了护理人员所感知的加速因素。
在这项多案例研究中，对STEMI护理人员进行了访谈、转录，并用于创建每个中心的流程描述。分析包括对流程的案例内分析和案例间分析。通过开放式编码和轴心式编码确定加速因素。
在六个PCI中心共进行了28次访谈。这些中心与指南推荐流程的不同之处在于，例如，额外的、不可避免的患者转诊和监测延迟，在诊断信息的沟通方面（如传输所有、仅模糊或不传输心电图）以及导管室准备方面彼此也存在差异。这些差异表明在速度和诊断准确性之间保持平衡的不同选择。护理人员认为加速流程的因素包括对初步诊断的信任，以及避免不必要的医护人员之间的会诊。流程和加速因素的组合在一个模型中进行了总结。
确定了PCI中心之间流程的众多差异。PCI中心应用了几种节省时间的策略，然而，配置不同。为了进一步改善对STEMI患者的护理，最佳实践可以在中心和国家之间共享。
