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Aust. J. Rural Health (2013) 22, 207
Letter to the Editor Do clinical pathways enhance access to evidence-based acute myocardial infarction treatment in rural emergency departments? (Leigh D. Kinsman, 2012) Australian Journal of Rural Health Volume 20, Issue 2, pages 59–66, April 2012 Dear Editor, I read with interest the study entitled ‘Do clinical pathways enhance access to evidence-based acute myocardial infarction treatment in rural emergency departments’. A cluster randomised controlled trial of six rural emergency departments, measured the impact of implementing an acute myocardial infarction clinical pathway, on thrombolytic administration. Although the implementation of the clinical pathways did not have any measurable impact, this was a valuable study. Small sample sizes and little knowledge of access, pretreatment and post-treatment contributed to the immeasurable impact. I think the size of the emergency departments (14 000–45 000 presentations a year) was the main contributor. Evidence shows that people living in rural communities are less likely to survive an acute myocardial infarction (AMI); the causes are attributed to a delay in accessing a hospital, thrombolytics, reperfusion therapy and cardiologists. Staff must be educated in advanced life support, be familiar with the use of clinical pathways and be confident decision makers. Rural doctors and clinical staff need to work as a team because of limited resources. Thirteen years working in a small rural health service (SRHS) has validated the existing research of higher mortality in rural areas relating to AMIs than metropolitan areas. It would be beneficial to assist these small
organisations in developing clinical pathways, as AMI presentations are low, staff turnover is high and the hospitals do not have resident doctors. Results would show valid improvements if clinical pathways were implemented where there are no existing clinical pathways. Providing a clear process for managing AMIs, and a system that’s replicated each presentation, will improve the time and episodes thrombolytics are administered. I encourage you to repeat the study in a cluster of SRHSs. Andrea Appelman Euroa Health Inc.
References 1 ACS-Guidelines-MJA-170406, Chew D, Allan R, Aroney C, Sheerin N. National data elements for the clinical management of acute coronary syndromes. The Medical journal of Australia 2005; 182 (9 Suppl): S1–S16. 2 Queensland health/flying doctors, Queensland Division. Primary Clinical Care Manual, Queensland Health, Queensland Govt, 7th Edition 2011. [Cited 2011]. Available from URL: http://www.health.qld.gov.au/pccm/. 3 Thiemann DR, Coresh J, Oetgen WJ, & Powe NR. The association between hospital volume and survival after acute myocardial infarction in elderly patients. N Engl J Med. 1999; 340: 1640–1648. May 27, 1999. doi:10.1056/ NEJM199905273402106 4 Kinsman LD. Do clinical pathways enhance access to evidence-based acute myocardial infarction treatment in rural emergency departments? Australian Journal of Rural Health 2012; 20: 59–66.
© 2014 The Author Australian Journal of Rural Health © National Rural Health Alliance Inc.
doi: 10.1111/ajr.12028
Aust. J. Rural Health (2013) 22, 207
Letter to the Editor Do clinical pathways enhance access to evidence-based acute myocardial infarction treatment in rural emergency departments? (Leigh D. Kinsman, 2012) Australian Journal of Rural Health Volume 20, Issue 2, pages 59–66, April 2012 Dear Editor, I read with interest the study entitled ‘Do clinical pathways enhance access to evidence-based acute myocardial infarction treatment in rural emergency departments’. A cluster randomised controlled trial of six rural emergency departments, measured the impact of implementing an acute myocardial infarction clinical pathway, on thrombolytic administration. Although the implementation of the clinical pathways did not have any measurable impact, this was a valuable study. Small sample sizes and little knowledge of access, pretreatment and post-treatment contributed to the immeasurable impact. I think the size of the emergency departments (14 000–45 000 presentations a year) was the main contributor. Evidence shows that people living in rural communities are less likely to survive an acute myocardial infarction (AMI); the causes are attributed to a delay in accessing a hospital, thrombolytics, reperfusion therapy and cardiologists. Staff must be educated in advanced life support, be familiar with the use of clinical pathways and be confident decision makers. Rural doctors and clinical staff need to work as a team because of limited resources. Thirteen years working in a small rural health service (SRHS) has validated the existing research of higher mortality in rural areas relating to AMIs than metropolitan areas. It would be beneficial to assist these small
organisations in developing clinical pathways, as AMI presentations are low, staff turnover is high and the hospitals do not have resident doctors. Results would show valid improvements if clinical pathways were implemented where there are no existing clinical pathways. Providing a clear process for managing AMIs, and a system that’s replicated each presentation, will improve the time and episodes thrombolytics are administered. I encourage you to repeat the study in a cluster of SRHSs. Andrea Appelman Euroa Health Inc.
References 1 ACS-Guidelines-MJA-170406, Chew D, Allan R, Aroney C, Sheerin N. National data elements for the clinical management of acute coronary syndromes. The Medical journal of Australia 2005; 182 (9 Suppl): S1–S16. 2 Queensland health/flying doctors, Queensland Division. Primary Clinical Care Manual, Queensland Health, Queensland Govt, 7th Edition 2011. [Cited 2011]. Available from URL: http://www.health.qld.gov.au/pccm/. 3 Thiemann DR, Coresh J, Oetgen WJ, & Powe NR. The association between hospital volume and survival after acute myocardial infarction in elderly patients. N Engl J Med. 1999; 340: 1640–1648. May 27, 1999. doi:10.1056/ NEJM199905273402106 4 Kinsman LD. Do clinical pathways enhance access to evidence-based acute myocardial infarction treatment in rural emergency departments? Australian Journal of Rural Health 2012; 20: 59–66.
© 2014 The Author Australian Journal of Rural Health © National Rural Health Alliance Inc.
doi: 10.1111/ajr.12028
