WMJ : official publication of the State Medical Society of Wisconsin
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Review of existing evidence supports that percutaneous coronary intervention (PCI) is superior to thrombolytic therapy in patients with acute myocardial infarction. If, however, a dedicated intervention team is not available onsite, transfer to another facility should be considered if reperfusion could be achieved within 90 minutes. ⋯ The value of administering full or modified dose thrombolytic therapy and then transferring for immediate PCI has not been demonstrated yet. Development of dedicated protocols for management of ST-elevation myocardial infarction developed by a community-based emergency medical service, emergency department, and cardiovascular service is highly recommended.
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The implementation of guidelines for treatment of Community-Acquired Pneumonia (CAP) has been proposed as a quality improvement and cost-saving strategy, though the effectiveness of several recommendations has yet to be confirmed through clinical trials. We sought to analyze the development and implementation of guidelines at our hospital, and to identify particular successes and impediments. ⋯ Our implementation of CAP guidelines was challenging but overall instructive and contributory to patient care. We review further areas for improvement.