Standard admission orders can improve the management of acute myocardial infarction

Int J Qual Health Care. 2012 Aug;24(4):425-32. doi: 10.1093/intqhc/mzs022. Epub 2012 May 16.


Objective: To evaluate whether the use of standard admission orders for patients admitted with acute myocardial infarction (AMI) is associated with better hospital quality of care.

Design: Secondary analysis of a population-based database derived from a large cluster randomized AMI quality improvement trial.

Setting: Seventy-eight acute care hospital corporations located in Ontario, Canada.

Participants: A total of 5338 patients with AMI admitted directly to the coronary care/intensive care units of participating hospitals in 2004/2005. Main outcome measure(s) Hospital performance on seven process-of-care measures and a combined composite process-of-care measure. Secondary outcomes were 30-day and 1-year mortality rates.

Results: Most patients (81%) were treated with standard admission orders. These patients were more likely to receive four of seven identified process-of-care measures (P< 0.05), including fibrinolytics ≤ 30 min or primary percutaneous coronary intervention ≤ 90 min of arrival, fibrinolytics administration decided by emergency department physician, aspirin ≤ 6 h of arrival and lipid test ≤ 24 h. After propensity-score matching (for risk adjustment), use of standard admission orders was not associated with significantly lower 30-day or 1-year mortality. However, patients who met the composite process-of-care measure had lower 30-day and 1-year mortality (relative risk= 0.51 (95% confidence interval (CI): 0.40-0.67) and 0.70 (95% CI: 0.58-0.84), respectively).

Conclusion: In AMI, the use of standard admission orders was associated with improved hospital performance on several but not all acute process-of-care quality indicators. The utilization of standard admission orders should be considered as a strategy for improving hospital care in patients admitted with AMI.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Clinical Protocols*
  • Emergency Service, Hospital / organization & administration*
  • Emergency Service, Hospital / standards
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / mortality
  • Myocardial Infarction / therapy*
  • Outcome and Process Assessment, Health Care
  • Patient Admission / statistics & numerical data*
  • Quality Indicators, Health Care
  • Quality of Health Care / organization & administration*
  • Quality of Health Care / standards
  • Risk Factors