Optimal care for Acute Coronary Syndromes (Reduction of Harm in Hospitals) (WC2008-074)

Background

Starting date: 01/09/2011

The program ‘Avoid harm, work safely (voorkom schade, werk veilig)’  has been initiated to promote patient safety in hospitals. Its ultimate goal is to decrease avoidable harm and avoidable mortality by 50%. An important part of the project is the use of a safety management program. This program contains ten high-risk themes, including the theme ‘Optimal care for Acute Coronary Syndromes (ACS)’. The ACS theme evaluates the care for patients with ST-elevation Myocardial Infarction (STEMI), Non ST-elevation Myocardial Infarction (NSTEMI) and Unstable Angina (UA). Optimal care for ACS is measured by one structure indicator, three process indicators and one outcome indicator.

Based on the agreement of 12th of June 2007, every hospital should have a fully operational safety management program by the end of 2012.

However, the task to measure and report their own performance, which was part of the agreement, was considered too much of a burden by the hospitals. This has, up until now, resulted in a failure to report these indicators. Furthermore, interim evaluation of the progress of implementation showed that it is unlikely that the goal of a fully operational safety management program in all hospitals by 2012 will be reached.

To evaluate the achievements of hospitals in the VMS safety program, the third NIVEL/EMGO+ evaluation study was initiated. In this study, the performances for the theme of ACS will be measured in a random sample of 12 hospitals throughout the Netherlands. The goal of the study is to explore the five indicators.

In order to get a thorough understanding of barriers and beneficial factors to the implementation of the ACS theme, semi-structured qualitative interviews will be held with members of the hospital management team and the cardiology department (cardiologists, nurses and medical students in residency). In these interviews, the management and medical staff described above will be asked about their experiences with implementing the safety management program, what factors obstructed effective implementation and what should be done about such factors. The influence of diagnostic performance and of information availability and processing in the chain of care for ACS will be studied more in-depth.

Finally, in order to assess the current quality of care for patients with ACS in their own perception, semi-structured interviews will be held. This will lead to an overview of patient experiences with care for ACS and their compliance with treatment advice.