Purpose: This work was aimed at identifying strategies for implementing clinical guidelines on acute myocardial infarction (AMI) care in emergency rooms of public general hospitals in Rio de Janeiro, Brazil
Method: A federal and three municipal hospitals were involved in the study, that included, traditional strategies applied in clinical guidelines implementation such as the delivering of the guidelines in a simplified format, flowcharts, remembers and other sensitizing materials. An innovative aspect of this project was the development of traineeships focused on AMI recognition and care, conducted by leader cardiologists in the hospitals, aimed at reaching not only doctors, nurses and the technical nursing, but also receptionists, vigilantes and other professionals acting in the reception of patients in the emergency rooms. An ante-post design was employed to evaluate the effects of the clinical guidelines implementation, accounting for changes in selected AMI care process indicators.
Result: The majority of cases was treated only in the emergency room, due to limitation in the number of coronary unit beds. Overall, we observed significant (p<0.05) increases in the utilization of multiple interventions such as, β-blockers, angiotensin-converting enzyme inhibitors, statins, intravenous nitrate, and coronary reperfusion in AMI with ST segment elevation. The use of aspirin since the first AMI day was already high and reached more than 95% of the cases after application of the strategies. Specially, we underline substantive and significant reductions in the opportunity loss for coronary reperfusion from about 70 to less than 20% in the post-program groups.
Conclusion: Despite some variations among the hospitals, we observed an expressive impact of ACI clinical guidelines implementation employing the strategies selected, what points out that their diffusion to other units may allow for AMI care improvement in the Unified Health System (SUS).
Candidate for the Lee B. Lusted Student Prize Competition