Clinical audit

DEPARTMENT OF
CARDIOLOGY AND
EMERGENCY MEDICINE
 Title of the Study:

Adherence / Compliance to the standard guidelines

for Management of Acute Coronary Syndrome (ACS)
 Inclusion Criteria:

Patients above 18 years of age

Patients with symptoms of chest pain within 12
hours
 Exclusion Criteria:

Patients below 18 years of age

Patients with symptoms of chest pain more than 12
hours
 Purpose of Audit:

The purpose of our study is the adherent to the

standard guidelines of managing Acute Coronary
Syndrome without any obvious contraindication.
For patients with the clinical presentation of STEMI
within 12 hours after symptom onset, early
mechanical (PCI) or pharmacological reperfusion
should be performed.
 Criteria of audit:

 To identify whether Aspirin was administered on arrival to the

hospital for all Acute Coronary syndrome patients in the absence of

any absolute contraindication.

 To establish time taken between arrival and thrombolysis.

 To establish time taken between arrival and balloon angioplasty.

 Clinical Audit Team:

Dr. Shiv Kumar , Cardiologist

Dr. Aftab Ahmed, Medical Superintendent
Dr. Syeda Shazia Tahseen, ER Incharge
Sis. Marina, Assistant Nursing Superintendant
Bro. Vibin, In-charge Nurse ER
Sis. Merin, In-charge Nurse CICU
 Target Values (Standards)
 100% of patients without contraindications should have
received Aspirin on Arrival.
 A minimum of 80% of patients without contraindications
should have been thrombolysed within 45 minutes from
arrival.
 A minimum of 80% of patients without contraindications
should have been inflated within 90 minutes from arrival.
 Duration of Study:

All Acute Coronary Syndrome patients admitted

during the period of January 2020 to December
2020 patients i.e., 1 year were considered for the
study
 Sampling & Sample Size:

Systematic sampling method was followed and a

total of 74 patients were considered for the study.
Type of Study:
Exploratory study was selected for data collection.

Methodology of Data Collection:

Secondary data has been collected by using a
predefined data Tracker Sheet. (Data Tracker
Sheet attached)
Data Analysis:
Data collected was analyzed was tabulated and
represented graphically by using line & control
charts.
All 74 patients presented with symptoms of Acute
Coronary Syndrome and fit into the criteria of
STEMI were evaluated and analyzed. (Data Sheet
attached)
 Compliance to Aspirin administration

100
95
90
85
80
Percentage

75
Desired
70
Trend
65
60
55
50
Jan-20 Feb-20 Mar- Apr-20 May- Jun-20 Jul-20 Aug- Sep-20 Oct-20 Nov- Dec-20
20 20 20 20
 Door to Needle time
80

Reason: Peak of COVID

70

60
58
55
52
50
47
45 45 45
TIME IN MIN

40 40 40

30 30

20
16

10

0 0
Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20
 Door to Balloon inflation time in ACS
160 Reason: Patient screening policy was not
defined and this was the peak COVID
time, hence the time increased in April
144 and May 2020
140
135

120 118

100
95 95
TIME IN MIN

89 Sustenance:
80 81 82 coordination between
Good 79
77 75 dept, and
ER, cardiology
67 mobilization of cathlab staff.
60

40

20

0
Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20
 Conclusion (Comparison with standards):

The above study reveals that the adherence /

Compliance to the standard guidelines for
Management of Acute Coronary Syndrome (ACS)
was found to be as per the targeted standards.
The door to needle time initially was beyond the
bench mark for which corrective measures were
implemented and in the last 4 months the bench
mark is being met. Protocols have to be formed and
implemented for sustenance of the trend.
 Scope of improvement for door to needle time

Early decision making regarding reperfusion

strategy Better patient counseling regarding
reperfusion strategy Early Mobilization of personnel
at each level from ER to cath lab including support
staff
 Recommendations

Learning with practicing cardiologists and clinicians

through CME’s, Clinical meetings, updating the new
standard protocols in Emergency Room, Cath Lab
and CICU was recommended. Holding classes and
discussions with junior doctors, technicians & nurses
were recommended to help improve the compliance
to the standard guidelines.
 References:

ACC/AHA Guidelines for the Management of

Patients With ST-Elevation Myocardial Infarction:
2013
http://circ.ahajournals.org/content/110/5/588.full
http://www.commit-ccs2.org
