Clinical Audit Data in Hospital for Cardiology Department.

1. CLINICAL AUDIT
OCT, NOV, DEC:2021
DURATION (3 MONTHS)

2. CLINICAL AUDIT
SET CLINICAL INDICATORS ON
(DOOR TO NEEDLE TIME)
1st CYCLE OF CLINICAL AUDIT

3. AIM
The American Heart Association and similar groups have established a
benchmark for the administration of thrombolytics in acute myocardial infarction
(AMI) patients as DOOR-TO-NEEDLE (DTN) time of 30 minutes or less.
Aim is to establish <30 minutes of thrombolysis door to needle time in MI
patients after diagnosis of MI.

4. PURPOSE
The purpose of this clinical audit was to determine whether the target
DTN time of 30 minutes or less for thrombolysis could be met in MI
patients.

5. SCOPE
• Physician has seen the patient.
• ECG was done on time.
• Patient received thrombolytic therapy.
• Patient were discharged from the hospital.

6. STANDARD
It sets out the name for each indicator along with the rationale, computation,
numerator, denominator, relevant inclusion and exclusions criteria, and associated
references.
It should 100 % comply.
The Time to Thrombolysis clinical audit for Myocardial Infarction provided the
opportunity to identify factors that delay thrombolytic treatment of patients with
ST-segment elevation acute myocardial infarction.
A case report form was developed to collect time points for emergency department arrival
(door), recording of the electrocardiogram (ECG) (data), entry of the order to give a
thrombolytic drug (decision), and initiation of the thrombolytic infusion (drug) as defined by
the National Heart Attack Alert Program.

7. CRITERIA
• All adult patients with acute ST segment elevation, or posterior infarct on
electrocardiogram (ECG) meeting AHA/ACC criteria for thrombolysis, Patients with
pulmonary thromboembolism who received thrombolytics in the above ECs.
• The time between the admission of AMI-suspected patients and treatment initiation.

8. DURATION OF AUDIT
Oct, Nov, Dec:
3 MONTHS OF 2021

9. METHOD AND DESIGN
•IT’S A RETROSPECTIVE SINGLE CENTER STUDY
•CHECKLIST
•DOCUMENTATION AND RECORD AUDIT
•CLINICAL CASE REVIEW
SAMPLING: 100 % patient Considered which are thrombolised.
AUDIT TOOL: Check list designed.
METHODOLOGY:Data were collected using checklists, completed by the patients’ next of kin or
the emergency staff. Clinical outcomes were defined as occurrence of myocardial infarction.

10. CHECKLIST
DOOR TO NEEDLE TIME
MONTH & YEAR:
S. NO.
PATIENT NAME
AGE
SEX
UHID/IPD NO
DATE & TIME OF ADMISSION
PATIENT ARRIVAL TIME AT EMERGENCY
TIME OF ECG AFTER ARRIVAL IN EMERGENC
CHIEF COMPLAINTS
PAIN HISTORY
OLD HISTORY OF CARDIAC DISEASE (YES/NO)
RISK FACTORS (DM / HTN/ DYSLIPIDAEMIA/
AF/SMOKING/ALCOHOLISM/ GENETICS/OTHERS)
TIME OF ECG AFTER THROMBOLYSIS
DOOR TO NEEDLE TIME (<30 MIN)
TIME TAKEN FOR ADMINISTRATION OF THROMBOLYTIC
AGENT
TYPE OF THROMBOLYTIC AGENT GIVEN
OUT COME OF INTERVENTION
PATIENT PRESCRIBED ANTI-THROMBOTIC THERAPY AFTER
THROMBOLYTIC(YES/NO)
REMARKS

11. FINDINGS

12. RESUT
DOOR TO NEEDLE TIME
MONTH
% OF PATIENT
THROMBOLYSED OUT
OF TOTAL EMERGENCY
ADMISSION
PATIENT INITIAL
ASSESSMENT TIME
AFTER ARRIVAL (<10
MIN)
TIME TO ECG AFTER
ARRIVAL <10 MIN
DOOR TO NEEDLE TIME OF
INTERVENTION
WITHIN <30 MINUTES
OCT-21 100% 100% 100% 100%
NOV-21 100% 100% 100% 100%
DEC-21
100% 100% 100%
100%
Total % 100% 100% 100% 100%

13. OBSERVATION
• All the thrombolization took place in the
emergency department
• All the patients ECG has been done but not
found in the patient files
• Personal histories has been taken but not
documented in the patient files
• Though all the practices are being followed but
documentation need improvement
4/1/19

14. RECOMMENDATIONS
• Door to Balloon time Should be < than 1 hour.
• In patients with STEMI timely reperfusion therapy with Door to Ballon time < 90 min is
recommended by current guidelines.
• Continuous association between shortening of Door to Balloon time & reduced risk of one year
mortality has been shown in trails.
• Considering this association, it calls for as per intervention rather than accepting specific cut
offs.
PLAN FOR RE AUDIT:
Re audit using the same checklist will be conducted for upcoming year
in the same time period, allowing for corrective measures to take effect.