Acute coronary syndrome: pharmacotherapy

Considering non-hospital data in clinical informatics use cases, a review of the National Emergency Medical Services Information System (NEMSIS)

Background

The National Emergency Medical Services (EMS) Information System (NEMSIS) Technical Assistance Center (TAC) collects and curates EMS activation level records for the United States. Originated as an outcomes assessment and service comparison tool, NEMSIS may have other high value clinical and public health uses.

Methods

This study acquired a 100% activation level public dataset for 2019 from NEMSIS TAC and assessed item response quantities. Subsumption of NEMSIS terms within other controlled clinical vocabularies was also considered.

Results

None of the assessed terminologies (LOINC, ICD10-CM, SNOMED-CT) could describe meaningful volumes of NEMSIS item response codes. The 2019 activation year dataset included 36,525 non-date/time or calculated distinct item responses for 43 activation descriptive items. Said item responses yielded 2,101,844,053 activation distinct non-blank responses. Several NEMSIS item responses had high clinical and public health value.

Conclusions

NEMSIS can support multiple public health use cases in addition to EMS outcomes assessment. A comprehensive custom value set is appropriate to integrate NEMSIS item response codes into controlled terminologies, FHIR or hospital Electronic Health Record applications.

Antiplatelet therapy in acute coronary syndromes: implications for nursing practice

The care of cardiovascular patients experiencing a myocardial infarction (MI) has evolved from simple bed rest and relief of pain to complex interventions and multiple medications that target both the short- and long-term risks associated with atherosclerosis and ischemia. Even the terminology has changed, from MI to acute coronary syndromes (ACSs). The term, acute coronary syndrome, refers to the clinical symptoms resulting from acute myocardial ischemia; it encompasses unstable angina, non-ST-elevation MI, and ST-elevation MI. Antiplatelet therapies are critically important in the management of patients with ACS. Antiplatelet therapies interfere with platelet aggregation and platelet activation both acutely and chronically and thus impact the development of acute MI. Thus, they are prescribed for millions of patients with ACS. As a result of this progress in treatment, nursing management of persons with ACS has also evolved. This article reviews the pathophysiology of ACS, the role of antiplatelet therapies, their effects on platelet adhesion, and the role of the nurse in caring for patients with ACS who are prescribed these important therapies.

The impact of emergency department structure and care processes in delivering care for non-ST-segment elevation acute coronary syndromes

BACKGROUND

We sought to assess the influence of emergency department (ED) structure and care processes on adherence to practice guidelines for the treatment of patients with non-ST-segment elevation acute coronary syndromes.

METHODS

We surveyed emergency physicians and nurses from 316 hospitals participating in the CRUSADE Quality Improvement Initiative and used multivariable modeling to correlate ED-specific characteristics with guidelines adherence.

RESULTS

Factors that were significantly associated with improved guidelines adherence included collaboration between emergency physicians and hospital administration, northeast region, adequate nursing support, use of locum tenens physicians, an independent ED (not a division of another clinical department), and use of a care algorithm for acute coronary syndromes.

CONCLUSIONS

Quality improvement strategies that have the full support of hospital administration, focus on increasing collaboration between emergency physicians and other health care providers, and specified protocol-driven management algorithm may be the most successful methods for improving the care and outcomes of patients with non-ST-segment elevation acute coronary syndromes.