• 作者：M.A. Castellano Ortega^a ; ^{macastellano@ephag.es} ; R.J. Romero de Castilla^b ; C. Rus Mansilla^c ; G.A. Cortez Quiroga^c ; A.J. Bayona Gó ; mez^a ; M.C. Duran Torralba^c
• 关键词：Unidad de dolor torá ; cico ; Ciclo de mejora ; Calidad asistencial
• 刊名：Revista de Calidad Asistencial
• 出版年：2011
• 期刊代码：pca305_1134282X
• 类别：med
• 出版时间：July-August 2011
• 卷：26
• 期：4
• 页码：242-250
• 文件大小：345 K

Objectives

The evaluation of an improvement cycle in patients suffering thoracic/chest pain in hospital emergencies, especially in those who could benefit from the early Bruce Treadmill Test.

Material and methods

A multidisciplinary group care protocol was designed, which identified improvement opportunities and gave priority to the fact that 芦an early Bruce Treadmill Test was carried out on fewer occasions than recommended禄. Causes were analysed (Ishikawa diagram) and six quality criteria were defined. These criteria were evaluated in a random sample of 30 patients out of the total of 180 who used the ergometer at the Hospital in the first six months of 2007, as well as questionnaire for the doctors. Corrective measures were introduced: circulation, accessibility through intranet and explicit information for new employees (doctors). The second evaluation was carried out during the first six-months of 2008 using another random sample of 30 patients from a total of 120.

Results

In the first evaluation, the classification of the risk according to the protocol was very low (100%non-compliance) and patients whose admission to the Chest Pain Unit was recommended and an early Bruce Treadmill Test (74%criteria failure) were referred to cardiology clinics. After implementation of the corrective measures, we obtain a general improvement in all the criteria, but very significant from the previous ones, with non-compliances being reduced to 17%in classification and to the 23%in referrals.

Conclusions

The structured cycle has helped resolve the priority problem in the short-term. The adopted measures have mainly been organisational, dependent on the professionals involved, and at a very low cost. Simple but organised methodological approaches should be taken into account before the incorporation of higher cost technologies.