• Aust J Rural Health · Apr 2012

    Randomized Controlled Trial Multicenter Study

    Do clinical pathways enhance access to evidence-based acute myocardial infarction treatment in rural emergency departments?

    • Leigh D Kinsman, Thomas Rotter, Jon Willis, Pamela C Snow, Penny Buykx, and John S Humphreys.
    • APHCRI Centre of Research Excellence in Rural and Remote Primary Health Care, School of Rural Health School of Psychology and Psychiatry, Monash University School of Public Health, La Trobe University, Bendigo, Victoria, Australia. leigh.kinsman@monash.edu
    • Aust J Rural Health. 2012 Apr 1; 20 (2): 59-66.

    Objective The objective of this study is to measure the impact of a five-step implementation process for an acute myocardial infarction (AMI) clinical pathway (CPW) on thrombolytic administration in rural emergency departments.Design Cluster randomised controlled trial.Setting  Six rural Victorian emergency departments participated.Intervention  The five-step CPW implementation process comprised (i) engaging clinicians; (ii) CPW development; (iii) reminders; (iv) education; and (v) audit and feedback.Main Outcome MeasuresThe impact of the intervention was assessed by measuring the proportion of eligible AMI patients receiving a thrombolytic and time to thrombolysis and electrocardiogram.ResultsNine hundred and fifteen medical records were audited, producing a final sample of 108 patients eligible for thrombolysis. There was no significant difference between intervention and control groups for median door-to-needle time (29 mins versus 29 mins; P = 0.632), proportion of those eligible receiving a thrombolytic (78% versus 84%; P = 0.739), median time to electrocardiogram (7 mins versus 6 mins; P = 0.669) and other outcome measures. Results showed superior outcome measures than other published studies.ConclusionsThe lack of impact of the implementation process for a chest pain CPW on thrombolytic delivery or time to electrocardiogram in these rural hospitals can be explained by a ceiling effect in outcome measures but was also compromised by the small sample. Results suggest that quality of AMI treatment in rural emergency departments (EDs) is high and does not contribute to the worse mortality rate reported for AMIs in rural areas.© 2012 The Authors. Australian Journal of Rural Health © 2012 National Rural Health Alliance Inc.

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