Standard admission orders can improve the management of acute myocardial infarction

Abstract

Objective: To evaluate whether the use of standard admission orders for patients admitted with acute myocardial infarction (AMI) is associated with better hospital quality of care. Design: Secondary analysis of a population-based database derived from a large cluster randomized AMI quality improvement trial. Setting: Seventy-eight acute care hospital corporations located in Ontario, Canada. Participants: A total of 5338 patients with AMI admitted directly to the coronary care/intensive care units of participating hospitals in 2004/2005. Main outcome measure(s): Hospital performance on seven process-of-care measures and a combined composite process-of-care measure. Secondary outcomes were 30-day and 1-year mortality rates. Results: Most patients (81%) were treated with standard admission orders. These patients were more likely to receive four of seven identified process-of-care measures (P< 0.05), including fibrinolytics ≤ 30 min or primary percutaneous coronary intervention ≤ 90 min of arrival, fibrinolytics administration decided by emergency department physician, aspirin ≤ 6 h of arrival and lipid test ≤ 24 h. After propensity-score matching (for risk adjustment), use of standard admission orders was not associated with significantly lower 30-day or 1-year mortality. However, patients who met the composite process-of-care measure had lower 30-day and 1-year mortality (relative risk = 0.51 (95% confidence interval (CI): 0.40-0.67) and 0.70 (95% CI: 0.58-0.84), respectively). Conclusion: In AMI, the use of standard admission orders was associated with improved hospital performance on several but not all acute process-of-care quality indicators. The utilization of standard admission orders should be considered as a strategy for improving hospital care in patients admitted with AMI. © The Author 2012. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.