Improving Adherence to the European Society of Cardiology’s 24-Hour to Coronary Angiogram Guideline

Abstract:

Healthcare accessibility in Ireland is the worst in Europe. The project site (north Dublin teaching hospital), had over 700 Emergency Department (ED) Non-ST- Elevated Myocardial Infarctions (NSTEMIs) in 2017. These NSTEMI's were associated with increased times to Coronary Angiogram (CA), when compared to the European Society of Cardiology's (ESC) 24-hour to CA guideline. Increased time to CA is associated with increased mortality. Using Lean Six Sigma (LSS) tools within the DMAIC (Define, Measure, Analyse, Improve, and Control) Quality Improvement (QI) model, the root causes of increased times to CA times were identified. One cause found was the use of non- high-sensitive troponin bloods to aid diagnosis of an NSTEMI. Process flow timing was analysed using patient data and value stream mapping. Results demonstrated 35% compliance with the ESC's 24-hour to CA guideline for high-risk NSTEMIs. The project site is bringing high-sensitive troponin blood analysis into practice. Analysis of a driver diagram resulted in a proposal of a National Institute for Health and Care Excellence (NICE) and ESC high-sensitive troponin protocol for triage to aid adherence to the ESC's 24-hour to CA guideline. When compared to non-high- sensitive troponin bloods taken in triage, high sensitive troponin bloods taken in triage allows for earlier diagnosis of an NSTEMI. Many strategies are also proposed to aid achieving adherence to the high-sensitive troponin protocol e.g. displaying the protocol on the projects site's smart-phone application. Some expected outcomes include: decreased time to CA and decreased patient complications. Some proposed control methods include data re-measurement and patient surveys.