The impact of emergency department structure and care processes in delivering care for non-ST-segment elevation acute coronary syndromes

Rajendra H. Mehta; L. Kristin Newby; Yogin Patel; James W. Hoekstra; Chadwick D. Miller; Anita Y. Chen; Barbara L. Lytle; Deborah B. Diercks; Richard L. Summers; Gerard X. Brogan; W. Frank Peacock; Charles V. Pollack; Matthew T. Roe; Eric D. Peterson; E. Magnus Ohman; W. Brian Gibler

doi:10.1016/j.ahj.2006.04.015

The impact of emergency department structure and care processes in delivering care for non-ST-segment elevation acute coronary syndromes

Rajendra H. Mehta, L. Kristin Newby, Yogin Patel, James W. Hoekstra, Chadwick D. Miller, Anita Y. Chen, Barbara L. Lytle, Deborah B. Diercks, Richard L. Summers, Gerard X. Brogan, W. Frank Peacock, Charles V. Pollack, Matthew T. Roe, Eric D. Peterson, E. Magnus Ohman, W. Brian Gibler

Research output: Contribution to journal › Article › peer-review

16 Scopus citations

Abstract

Background: We sought to assess the influence of emergency department (ED) structure and care processes on adherence to practice guidelines for the treatment of patients with non-ST-segment elevation acute coronary syndromes. Methods: We surveyed emergency physicians and nurses from 316 hospitals participating in the CRUSADE Quality Improvement Initiative and used multivariable modeling to correlate ED-specific characteristics with guidelines adherence. Results: Factors that were significantly associated with improved guidelines adherence included collaboration between emergency physicians and hospital administration, northeast region, adequate nursing support, use of locum tenens physicians, an independent ED (not a division of another clinical department), and use of a care algorithm for acute coronary syndromes. Conclusions: Quality improvement strategies that have the full support of hospital administration, focus on increasing collaboration between emergency physicians and other health care providers, and specified protocol-driven management algorithm may be the most successful methods for improving the care and outcomes of patients with non-ST-segment elevation acute coronary syndromes.

Original language	English (US)
Pages (from-to)	648-660
Number of pages	13
Journal	American heart journal
Volume	152
Issue number	4
DOIs	https://doi.org/10.1016/j.ahj.2006.04.015
State	Published - Oct 2006

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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Mehta, R. H., Newby, L. K., Patel, Y., Hoekstra, J. W., Miller, C. D., Chen, A. Y., Lytle, B. L., Diercks, D. B., Summers, R. L., Brogan, G. X., Peacock, W. F., Pollack, C. V., Roe, M. T., Peterson, E. D., Ohman, E. M., & Gibler, W. B. (2006). The impact of emergency department structure and care processes in delivering care for non-ST-segment elevation acute coronary syndromes. American heart journal, 152(4), 648-660. https://doi.org/10.1016/j.ahj.2006.04.015

Mehta, RH, Newby, LK, Patel, Y, Hoekstra, JW, Miller, CD, Chen, AY, Lytle, BL, Diercks, DB, Summers, RL, Brogan, GX, Peacock, WF, Pollack, CV, Roe, MT, Peterson, ED, Ohman, EM & Gibler, WB 2006, 'The impact of emergency department structure and care processes in delivering care for non-ST-segment elevation acute coronary syndromes', American heart journal, vol. 152, no. 4, pp. 648-660. https://doi.org/10.1016/j.ahj.2006.04.015

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title = "The impact of emergency department structure and care processes in delivering care for non-ST-segment elevation acute coronary syndromes",

abstract = "Background: We sought to assess the influence of emergency department (ED) structure and care processes on adherence to practice guidelines for the treatment of patients with non-ST-segment elevation acute coronary syndromes. Methods: We surveyed emergency physicians and nurses from 316 hospitals participating in the CRUSADE Quality Improvement Initiative and used multivariable modeling to correlate ED-specific characteristics with guidelines adherence. Results: Factors that were significantly associated with improved guidelines adherence included collaboration between emergency physicians and hospital administration, northeast region, adequate nursing support, use of locum tenens physicians, an independent ED (not a division of another clinical department), and use of a care algorithm for acute coronary syndromes. Conclusions: Quality improvement strategies that have the full support of hospital administration, focus on increasing collaboration between emergency physicians and other health care providers, and specified protocol-driven management algorithm may be the most successful methods for improving the care and outcomes of patients with non-ST-segment elevation acute coronary syndromes.",

author = "Mehta, {Rajendra H.} and Newby, {L. Kristin} and Yogin Patel and Hoekstra, {James W.} and Miller, {Chadwick D.} and Chen, {Anita Y.} and Lytle, {Barbara L.} and Diercks, {Deborah B.} and Summers, {Richard L.} and Brogan, {Gerard X.} and Peacock, {W. Frank} and Pollack, {Charles V.} and Roe, {Matthew T.} and Peterson, {Eric D.} and Ohman, {E. Magnus} and Gibler, {W. Brian}",

note = "Funding Information: CRUSADE is funded by the Schering-Plough Corporation, Kenilworth, NJ. Bristol-Myers Squibb/Sanofi-Aventis Pharmaceuticals Partnership, New York, NY and Paris, France, provides additional funding support. Millennium Pharmaceuticals, Inc, Cambridge, MA also provided funding for this work. Copyright: Copyright 2008 Elsevier B.V., All rights reserved.",

year = "2006",

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doi = "10.1016/j.ahj.2006.04.015",

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T1 - The impact of emergency department structure and care processes in delivering care for non-ST-segment elevation acute coronary syndromes

AU - Mehta, Rajendra H.

AU - Newby, L. Kristin

AU - Patel, Yogin

AU - Hoekstra, James W.

AU - Miller, Chadwick D.

AU - Chen, Anita Y.

AU - Lytle, Barbara L.

AU - Diercks, Deborah B.

AU - Summers, Richard L.

AU - Brogan, Gerard X.

AU - Peacock, W. Frank

AU - Pollack, Charles V.

AU - Roe, Matthew T.

AU - Peterson, Eric D.

AU - Ohman, E. Magnus

AU - Gibler, W. Brian

N1 - Funding Information: CRUSADE is funded by the Schering-Plough Corporation, Kenilworth, NJ. Bristol-Myers Squibb/Sanofi-Aventis Pharmaceuticals Partnership, New York, NY and Paris, France, provides additional funding support. Millennium Pharmaceuticals, Inc, Cambridge, MA also provided funding for this work. Copyright: Copyright 2008 Elsevier B.V., All rights reserved.

PY - 2006/10

Y1 - 2006/10

N2 - Background: We sought to assess the influence of emergency department (ED) structure and care processes on adherence to practice guidelines for the treatment of patients with non-ST-segment elevation acute coronary syndromes. Methods: We surveyed emergency physicians and nurses from 316 hospitals participating in the CRUSADE Quality Improvement Initiative and used multivariable modeling to correlate ED-specific characteristics with guidelines adherence. Results: Factors that were significantly associated with improved guidelines adherence included collaboration between emergency physicians and hospital administration, northeast region, adequate nursing support, use of locum tenens physicians, an independent ED (not a division of another clinical department), and use of a care algorithm for acute coronary syndromes. Conclusions: Quality improvement strategies that have the full support of hospital administration, focus on increasing collaboration between emergency physicians and other health care providers, and specified protocol-driven management algorithm may be the most successful methods for improving the care and outcomes of patients with non-ST-segment elevation acute coronary syndromes.

AB - Background: We sought to assess the influence of emergency department (ED) structure and care processes on adherence to practice guidelines for the treatment of patients with non-ST-segment elevation acute coronary syndromes. Methods: We surveyed emergency physicians and nurses from 316 hospitals participating in the CRUSADE Quality Improvement Initiative and used multivariable modeling to correlate ED-specific characteristics with guidelines adherence. Results: Factors that were significantly associated with improved guidelines adherence included collaboration between emergency physicians and hospital administration, northeast region, adequate nursing support, use of locum tenens physicians, an independent ED (not a division of another clinical department), and use of a care algorithm for acute coronary syndromes. Conclusions: Quality improvement strategies that have the full support of hospital administration, focus on increasing collaboration between emergency physicians and other health care providers, and specified protocol-driven management algorithm may be the most successful methods for improving the care and outcomes of patients with non-ST-segment elevation acute coronary syndromes.

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The impact of emergency department structure and care processes in delivering care for non-ST-segment elevation acute coronary syndromes

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