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Managing in-hospital quality improvement

Tijdschriftbijdrage - Tijdschriftartikel

Ondertitel:An importance-performance analysis to set priorities for ST-elevation myocardial infarction care

BACKGROUND: A focus on specific priorities increases the success rate of quality improvement efforts for broad and complex-care processes. Importance-performance analysis presents a possible approach to set priorities around which to design and implement effective quality improvement initiatives. Persistent variation in hospital performance makes ST-elevation myocardial infarction care relevant to consider for importance-performance analysis.

AIMS: The purpose of this study was to identify quality improvement priorities in ST-elevation myocardial infarction care.

METHODS: Importance and performance levels of ST-elevation myocardial infarction key interventions were combined in an importance-performance analysis. Content validity indexes on 23 ST-elevation myocardial infarction key interventions of a multidisciplinary RAND Delphi Survey defined importance levels. Structured review of 300 patient records in 15 acute hospitals determined performance levels. The significance of between-hospital variation was determined by a Kruskal-Wallis test. A performance heat-map allowed for hospital-specific priority setting.

RESULTS: Seven key interventions were each rated as an overall improvement priority. Priority key interventions related to risk assessment, timely reperfusion by percutaneous coronary intervention and secondary prevention. Between-hospital performance varied significantly for the majority of key interventions. The type and number of priorities varied strongly across hospitals.

CONCLUSIONS: Guideline adherence in ST-elevation myocardial infarction care is low and improvement priorities vary between hospitals. Importance-performance analysis helps clinicians and management in demarcation of the nature, number and order of improvement priorities. By offering a tailored improvement focus, this methodology makes improvement efforts more specific and achievable.

Tijdschrift:  Eur J Cardiovasc Nurs
ISSN: 1474-5151
Issue: 6
Volume: 17
Pagina's: 535-542
Jaar van publicatie:2018
Trefwoorden:Quality improvement, acute coronary syndrome, evidence-based medicine, importance-performance analysis
BOF-keylabel:ja
BOF-publication weight:1
CSS-citation score:1
Auteurs:Regional
Authors from:Higher Education
Toegankelijkheid:Closed