Impact of a clinical pathway for acute myocardial infarction on length of stay and quality of care in intensive care units of the critical care department of Alexandria Main University Hospital

ABSTRACT

A clinical pathway defines the optimal care process, sequencing and timing of interventions for a particular diagnosis or procedure. Clinical pathway implementation has the potential to standardize treatment and improve outcomes. Therefore the aim of this study is to determine whether clinical pathway implementation would alter process of care, hospital stay and mortality rates for acute myocardial infarction at Alexandria Main University Hospital. The study consisted of three phases pre-intervention phase, development and dissemination of a clinical pathway for acute myocardial infarction and post- intervention evaluation phase. Process and outcome indicators were used to assess the quality of care provided to patients with acute myocardial infarction before and after implementation of the pathway. Results revealed that 4 process indicators out of 7 showed significant improvement namely, the utilization of thrombolytic therapy [from 76.9 to 88.5%], B-blockers at admission [from 28.5% to 50.0%], ACE inhibitors at discharge [from 61.2% to 75.2%] and smoking cessation counselling [from zero to 86.7%]. There was also reduction of variation in length of ICU stay as 67.7% achieved length of stay goal of 3 days after implementation of the pathway. ICU mortality was decreased from 20.8% to 6.9% after implementation of the pathway. These data suggest that the implemented acute myocardial infarction pathway lead to improved patient care and utilization of resources by providing a structured framework and educational guide to assist in the delivery of care to patients admitted with myocardial infarction