• K N Markel and S A Marion.
• Department of Emergency Medicine, Richmond Hospital, British Columbia, Canada.
• J Emerg Med. 1996 Nov 1;14(6):685-9.

AbstractThe objective of this study was to implement a system of continuous quality improvement to reduce delays in the administration of thrombolytic therapy for patients with acute myocardial infarction in the emergency department (ED). The setting was a community hospital ED with an annual census of approximately 40,000 patients. The participants included all patients presenting to the ED with a diagnosis of acute myocardial infarction eligible for thrombolytic therapy. A cross-functional team analyzed the process of events that occurred from the arrival of a patient in the ED to treatment with thrombolytic therapy. The entire process was documented in a process flow diagram. Measurements of key time intervals were made, and remedies were designed and implemented based on these results. In the postintervention period, the performance level of the new process was evaluated and the results were compared with those in the preintervention period. In the postintervention period, the median elapsed time from ED admission to thrombolysis was 40 min, which was significantly shorter that the median preintervention time of 62 min. This study successfully applied the theory of continuous quality improvement to reduce the delays to thrombolytic therapy for patients with acute myocardial infarction in the ED.

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