| Background:Over the last twenty years, various guidelines has been developed on the basis of evidence-based medicine in the field of cardiovascular disease, but still there are wide gaps between evidence based-medicine or guidelines and clinical practice. The clinical pathways have been developed to guide and standardized the diagnosis and treatment of certain diseases, to optimize smooth patient care, and its application has been proven to regulate the medical practice and to improve the quality of medical care in developed countries.Objective:To analyze and evaluate the diagnosis and treatment of acute coronary syndrome (ACS) after the implementation of clinical pathways and to identify the areas need to be improved in clinical practice in Xiangya Third Hospital of Central South University.Methods:We set up a quality control team for clinical pathway for acute coronary syndrome, headed by the director, and a deputy director as a full-time project coordinator, who was responsible for the implementation of clinical pathways by all of resident doctors and house officers. Then the first consecutive50patients with the diagnosis of ACS were collected as baseline from our hospital since December2009. By observing the clinical pathways for acute coronary syndrome issued by the Ministry of Health, we try to find gaps and areas to be improved, and to develop suitable pathway for medical diagnosis and treatment in our hospital. Then we continued to collect data of next consecutive50patients with the diagnosis of ACS as the first group, which was compared with baseline group to find the potential area of improvement, and then data of next50ACS patients was collected, which was also compared with the baseline group. At last, with same procedure, patients in four groups,50in each, were recruited till December2011. Then the data of our hospital and some tertiary hospitals of china were compared and analyzed.Results:After the implementation of clinical pathways we have found:1. Compared with baseline group, the proportion of STEMI patients arriving at hospital within12hours of onset of symptoms was increased (P<0.05), and the proportion of patients whose final diagnosis consistent with cardiac markers was also increased (P<0.05).2. The proportion of the patients who used the drugs like antiplatelets (aspirin, clopidogrel), β-Blocker, ACEI/ARB, and statin in our hospital was higher but not statically significant (P>0.05), and the use of clopidogrel and statin was significantly higher (P<0.05) than that of other tertiary hospitals of China. 3. There was no significant difference (P>0.05) in Door-to-needle time or Door-to-balloon time in our hospital, though they were longer than standard guidelines, but the door-to-needle time was shorter when compared with other tertiary hospitals.4. TIMI risk score of UA/NSTEMI patients and invasive therapy (PCI) was negatively correlated (r=-0.312, P<0.05) in our hospital, and the results were similar when compared with other tertiary hospitals.5. The number high-risk patients in our hospital increased, but there was no significant difference in mortality (P>0.05).Conclusion:1. Implementation of clinical pathway helped to improve the collaboration between the emergency and cardiology department, and to standardize the methods of cardiac markers detection in our hospital.2. Implementation of clinical pathways may improve patient outcome.3. Compared with low risk patients (NSTEMI/UA), high risk patients have undergone less number of invasive therapies (PCI).4. There are still certain gaps between the clinical practice and guidelines which need to be fulfilled. |
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