Development of Care Network for Patients with Non ST Elevation Myocardial Infarction at Sakon Nakhon Province

Abstract

         The action research aimed to develop the care network for patients with Non ST elevation myocardial infarction (NSTEMI) at Sakon Nakhon province and study of the outcome of network development. Data were collected in group meeting and participant observation. Data collection tools consisted of patient data collection form applied from Thai ACS registry, SWOT analysis and clinical practice guidelines for patients with NSTEMI. Purposive sampling was applied for network development and evaluation groups. The research was carried out in the first phase: Preparation (policy setting for network development, network strategy, analysis and strategy planning), Second phase: Development of care network for patients with NSTEMI and third phase: Outcome evaluation. The quantitative data were analyzed using frequency, percentage and standard deviation. The qualitative data were analyzed using content analysis.

          The results showed that the development of care network for patients with NSTEMI through 3 strategic plans, “Know fast – Call fast – Get fast – Come fast – Treats fast”, “Smart team – Strong heart – Ready to share” and “Seamless integrated service” has created the seamless integrated network consisted of 1) the patient care system according to the clinical practice guideline for Sakon Nakhon network named “one protocol one province” 2) full–service system, screening system and patient care in network hospital before referring to Sakon Nakhon hospital to gain access to cardiac catheterization according to the severity before discharge, development of multidisciplinary team to follow up patients to prevent the recurrence 3) Cardiology consultation system which access easily in 24–hour 4) availability of medicines, equipments and instruments and circulatory use within Sakon Nakhon province 5) strengthening competency of cardiac care team continuously using team learning, outreach to educate personnel of the multidisciplinary team in network hospitals and 6) coordinated nursing system. The clinical outcome showed 90.55 % of NSTEMI patients received coronary artery intervention. In–hospital mortality and 30–day mortality were decreased from 12.02 ± 6.46 to 5.3 ± 4.17 and 6.46 ± 8.72 to 3.85 ± 4.27, respectively. In conclusion, the strategies of this study had improved the patient care network, the expansion to the Health Service Area 8 should be recommended to increase the care accessibility of patients with NSTEMI.
           Keywords: Development of care network, Non ST elevation myocardial infarction