Author:
Tuazon Cecileen Anne M,Alad Paul Anthony O,Rollorazo Albert Roy M,Evangelista Lauren Kay,Agustin Ruth Divine,Ramiro Valerie,Pilapil John Christopher,Velando Bianca,Abaca Mark Joseph M,Mapili Jerahmeel Aleson L,Tamondong-Lachica Diana R,Sison Eric Oliver D,Añonuevo John C,Punzalan Felix Eduardo R
Abstract
BACKGROUND: Acute coronary syndrome (ACS) is a leading cause of admission and mortality in a tertiary care hospital in the Philippines. The significant burden of the disease necessitates that evidence-based care set by international and local guidelines be met to improve service delivery and quality of care (QOC). Institution-specific QOC studies showed gaps between guideline recommendations and compliance. Development and utilization of a clinical pathway are among the identified strategies to improve compliance. It is also crucial for implementation of standard-of-care set specific to a hospital setting based on its needs and resources.
METHODS: This is a descriptive research on the development of a clinical pathway for ACS appropriate for the emergency room setting of a tertiary care hospital from March 2021 to August 2022. Local QOC studies and evidence behind the latest international guideline recommendations on the management of ACS were reviewed to create the interim ACS Pathway. Two-level content validation of the interim pathway was done: internal validation with the consultants and fellows of the Division of Cardiovascular Medicine and external validation through focused group discussions with different hospital units and stakeholders to assess applicability and feasibility based on the resources of the setting, identify hindrances, and propose solutions in its implementation.
RESULTS: An evidence-based clinical pathway for ACS that encompasses identification and management of ST-segment elevation myocardial infarction and non–ST-segment elevation acute coronary syndrome with judicious use of locally available and feasible resources applicable for local emergency room hospital setting was created.
CONCLUSION: Review of local QOC studies and interdepartmental collaboration are necessary components in developing institution-specific clinical pathway for ACS.
KEYWORDS: acute coronary syndrome, clinical pathway, quality of care
Publisher
Philippine Heart Association
Reference26 articles.
1. World Health Organization. Cardiovascular Diseases. Geneva, Switzerland: WHO; 2021.
2. Department of Health. The 2018 Philippine Health Statistics. 2018
3. Roque VL, Besa JJ, Medina H, Nicolas A, Magnaye FM. 2019 Ward Services Year-End Report. 2020. Internal document.
4. Jneid H, Addison D, Bhatt, DL, et al. 2017 AHA/ACC clinical performance and quality measures for adults with ST-elevation and non-ST-elevation myocardial infarction: a report of the American College of Cardiology/ American Heart Association Task Force on Performance Measures. Circulation 2017;10(10).
5. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation;Ibanez;Eur Heart J,2018