Article Text
Abstract
Aims To standardise the inpatient management of Non-ST elevation acute coronary syndrome (NSTE-ACS) in our tertiary cardiology centre by developing an innovative pathway that integrates care from all members of the multi-disciplinary team (MDT) involved in the patient journey.
Methods We retrospectively collected data on all cardiology admissions from January 2020 to April 2020 with a discharge diagnosis of NSTE-ACS. We collected informal feedback from representatives of the MDT involved in all stages of the patient journey.
Results
21% and 33% of patients were screened for diabetes and dyslipidaemia, respectively.
84% of patients who underwent coronary angiography met the ESC criteria for high-risk NSTE-ACS. Gold standard management for this group is coronary angiography within 24 hours. In our audit, 51% of patients reached angiography within 24 hours.
Current use of multiple notes creates the potential for patient safety issues, integrating notes across disciplines would reduce this.
Variation in discharge planning and advice, with delays to discharge to clarify outpatient follow up and discharge medications.
Interventions Immediate Intervention - educating the MDT regarding gold standard care, specifically screening for risk factors.
Short term intervention - introduction of a ‘cardiac risk factor’ screening sticker to improve risk factor identification over 1 month.
Long Term Intervention – NSTE-ACS multi-disciplinary pathway to include the medical notes, nursing notes and procedural notes if coronary angiography is undertaken. This will improve the efficiency of listing patients who meet the ESC criteria for ‘high-risk NSTE-ACS’ for urgent angiography.
By including a section on risk factor management, we hope to see a sustained improvement in screening for diabetes and dyslipidaemia.
Finally, it will include a summary of the patients’ journey which can be translated accurately onto a discharge letter.