Development of ST- Elevation Myocardial Infarction Care Network in Kamphaeng Phet - การพัฒนาเครือข่ายการรักษาพยาบาล ผู้ป่วยภาวะกล้ามเนื้อหัวใจตายเฉียบพลัน ชนิดคลื่นไฟฟ้าหัวใจเอสทียกสูง (STEMI) จังหวัดกำแพงเพชร

Abstract

        The ST-Elevation Myocardial Infarction (STEMI) is an emergency situation that requires immediately opens the coronary arteries unless this may lead to death. The objective of this study was to develop and study the outcome of the STEMI care network in Kamphaeng Phet province. The study was conducted as an action research consisted of 2 steps, which included (1) analyzing the situation by reviewing 268 medical records filed with STEMI registry and focus group of 3 physicians, 12 Kamphaeng Phet hospital nurses, 20 district hospital nurses, and creating the baseline network database using content analysis and descriptive statistic methods, (2) developing a care network comprised of staff competency development,
screening guideline, clinical practice guideline, handbook of thrombolytic drug administration and nursing care, guideline on communication between hospitals, fast track of thrombolytic therapy, infrastructure and resource management, and innovation and management information system (MIS), implemented in 2 problem solving cycles, and (3) comparing the results observed in 3 period: before (Oct. 2006-Mar. 2009), 1st implementation (Oct. 2009-Sep. 2012) and 2nd implementation (Oct. 2012-Sep. 2014)
cycles after development in 268, 352 and 222 STEMI patients respectively, using Chi-square and median test. As for the results, the baseline data revealed that 29.5% of patients received the thrombolytic drug with total ischemic time of 9:45 hours and the mortality rate of 36.6%. The need for emergency patient management guideline was raised in the focus group discussion. After the development of 1st and 2nd cycles, the thrombolytic drug receiving rates were 70.5% and 72.1% respectively, and the total
ischemic time decreased to 4:14 and 3:07 hours with the mortality rate of 25.4% and 13.5% before and after comparison at p<0.05. The further suggestion of the ST-Elevation treatment network should include Man, Method, Money, Material and MIS development.
Key words: myocardial infarction, care network, STEMI