Assessment of the clinical pathway effect for acute myocardial infarction

AIM:To optimize the diagnosis and treatment process,narrow the gap between clinical medicine and evidence-based medicine,improve the quality of diagnosis and treatment,reduce medical expenses,use limited medical service resources reasonably and offer patients the highest benefit.METHODS:According to ACC/AHA and Chinese acute coronary syndrome diagnosis and treatment guidelines,we developed our AMI clinical pathway and implemented its use in our hospital.Every 6 months an evaluation of the clinical pathway implemented was conducted in 76 AMI patients(admitted from October 2006 to March 2008) as a baseline before the implementation and 98 AMI patients(admitted from April 2008 to September 2009) after the implementation.RESULTS:After implementation of the clinical pathway,hospitalization time was significantly shortened,with a 3.5-day reduction in ST segment elevation myocardial infarction(STEMI) patients and 6.14-day reduction in non-STEMI patients(P<0.05).The rate of high-risk patients undergoing coronary angiography increased from 48% to 78%(P<0.01),whereas the "door-to balloon"(DB) time of STEMI patients decreased by 43%(P<0.01).The rate of early reperfusion in STEMI patients arriving at the hospital within 12 h was enhanced from 67% to 87%,combined use of ACEI/ARB markedly increased(P<0.05) and mortality rate in AMI patients decreased by 9.8%(P<0.05).CONCLUSION:Implementation of the clinical pathway for AMI patients greatly reduces hospitalization days,decreases DB time,increases proportion of emergency PCI for STEAMI patients and significantly reduces mortality rate.