Original articles |
* Royal Cornwall Hospital, Truro, UK;
Royal Hampshire County Hospital, Winchester, UK;
Biostatistics & Epidemiology Department, School of Health Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
Correspondence to: EL Email: eylem{at}doctors.org.uk
The use of integrated care pathways (ICPs) to enhance quality and consistency of patient care has increased in the last decade. In two closely related studies, we first assessed the benefit of a new ICP for acute coronary syndrome in our district hospital, and secondly assessed the impact of ICPs in UK coronary care units, correlating with data from the Myocardial Infarction National Audit Programme, MINAP. The new local ICP produced statistically improved admission medication, with the chance of correctly prescribing aspirin increasing by 63% (P < 0.002), and borderline increase for clopidogrel of 28% (P > 0.10), and enoxaparin of 21% (P > 0.06), in a completed audit cycle study totalling 100 patients. A national telephone survey showed that of 210 UK coronary care units, only 40% had an ICP in place, and this made no difference to either door-to-needle time for thrombolysis or to rates of discharge medication with aspirin, beta-blockers or statins.While these results fail to raise enthusiasm for implementing an ICP, other potential benefits of their use may be important such as optimizing data collection, improving consistency of care and unifying the different clinical teams in planning the care of the patient.
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