Development of STEMI Fast Track in Accidental and Emergency Department, Waritchaphum Hospital, SakonNakhon Province. การพัฒนาระบบบริการช่องทางด่วนสำหรับผู้ป่วยโรคกล้ามเนื้อหัวใจขาดเลือดเฉียบพลันชนิด STEMI ในงานผู้ป่วยอุบัติเหตุและฉุกเฉิน โรงพยาบาลวาริชภูมิ จังหวัดสกลนคร

บทคัดย่อ

            The participatory action research aims to develop the STEMI Fast Track in Accidental and Emergency Department at Waritchaphum hospital, Sakon Nakhon province.The participants consisted of 2 groups. The main informant is the patient care development team consisted of 10 healthcare providers. The principle co-researchers comprised of 35 patients with STEMI and multidisciplinary team consisted of 25 personnel who were responsible for patient care in the hospital. The study was conducted from October 2014 to September 2017. Data were collected with both qualitative and quantitative methods. Qualitative data were analyzed as content analysis and summary. Quantitative data were analyzed using a descriptive statistics; frequency, percentage, and mean. The results revealed that

          1) for the patient care situation, the problems were delay to access the service and the high mortality rate. Four causes were summarized. 1.1 the service system aspect; no patient care guideline, no STEMI fast track care, no knowledge providing and the limit of definitive care, 1.2 the clients aspect; lack of disease knowledge and early warning signs and did not call 1669 service, 1.3 the healthcare provider aspect; lack of disease knowledge, lack of direct responsible person, the separate service, no expert consultation system, 1.4 The equipment and medications aspect; no automated external defibrillator and no electrocardiogram machine and on thrombolytic drugs.

          2) The development of STEMI Fast Track consisted 3 main components; 2.1 the development of clinical practice guideline for 3 related phases of care; pre-hospital phase, in-hospital phase and inter-hospital and referral system, 2.2 the setting of Time Control Designs for STEMI Fast track service and 2.3 the multidisciplinary care with the case manager nurse.

          3) The outcomes of patient care after the development of STEMI fast tract from year 2014 to 2017 were the decreased average time to service access into the target criteria (< 90 min), the decreased door to EKG to the target criteria (< 5 min) in year 2017, the decreased average time of door to thrombolytic agent from 71 to 62 ,47 and  46 min, respectively, the decreased mortality rate to 27.2% in year 2016 and 16.1% in 2017 and the increased satisfactory of both service provider and client.

          Keywords:  Acute ST-segment elevation myocardial infarction, STEMI Fast Track