Development of a Health Care System for Patients with ST-elevated Myocardial Infarction in Kamalasai Hospital

Abstract

This action research aimed to develop and enhance the care system for patients with ST-elevation myocardial infarction (STEMI) in the Emergency and Forensic Medicine Department at Kamalasai Hospital. Conducted from October 2023 to September 2024, the study employed a participatory approach involving three target groups: (1) ten multidisciplinary professionals responsible for system development, (2) ten healthcare providers, including physicians, nurses, pharmacists, dietitians, and physical therapists, and (3) eleven patients and their relatives who had undergone treatment. Research instruments included a STEMI care system assessment form, clinical indicator records, a personnel knowledge and skill assessment test, and in-depth interviews with focus group discussions. Data were analyzed using descriptive statistics and content analysis.

The research was structured into three phases.

Phase 1 (situation analysis) identified critical deficiencies in the existing STEMI care system, notably a prolonged door-to-needle time exceeding the 30-minute standard and a high mortality rate of 45.45%. Contributing factors included the absence of standardized clinical protocols, inefficient interdepartmental coordination—especially outside regular working hours—and inadequate preparedness of personnel and equipment.

Phase 2 (system development) was implemented through two iterative cycles: the first focused on establishing a Fast Track system, standardized clinical practice guidelines, and personnel capacity-building programs, while the second addressed gaps identified in the initial cycle, such as optimizing referral pathways and enhancing electrocardiogram (ECG) interpretation skills. Post-development outcomes demonstrated a significant improvement, with the door-to-needle time reduced to 27 minutes, aligning with international standards.

Phase 3 (evaluation) revealed statistically significant reductions in patient mortality, alongside marked improvements in personnel competency, as evidenced by an increase in mean knowledge and skill assessment scores from 65% pre-training to 85% post-training. Additionally, patient satisfaction with the provided services increased from 76% to 90%. System-wide advancements included the institutionalization of a STEMI Kit, the integration of an electronic performance monitoring system, and the establishment of a streamlined communication protocol for emergency STEMI cases.

In conclusion, the study underscores the efficacy of a structured, iterative approach to emergency cardiovascular care system enhancement. The findings highlight the necessity of standardized protocols, interdisciplinary collaboration, and continuous quality improvement to optimize STEMI treatment outcomes. These results provide a scalable model for improving emergency cardiac care systems in similar healthcare settings.