Development of a virtual tool for monitoring quality of care in acute myocardial infarction via the internet

BACKGROUNDMeasurement of quality indicators contributes to monitoring the performance of initial treatment of ST-elevated myocardial infarction (STEMI).OBJECTIVETo develop a virtual tool to calculate performance indicators of initial treatment of STEMI online via the internet.METHODSWe identified critical elements of the therapeutic process and formulated indicators in a retrospective pilot study, and developed a virtual tool for prospective data collection on initial treatment of STEMI. Rio de Janeiro hospitals with emergency care units were selected and invited to participate in the project. Online reports were developed to be accessed at www.qualiiam.icict.fiocruz.br/indicadores.php and analyzed.RESULTSFive hospitals agreed to participate in the project and monitored treatment of different numbers of patients with a diagnosis of STEMI (A = 7, B = 14, C = 16, D = 44 and E = 43). Aspirin was administered in 94.6% of cases, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in 76.1% and beta-blockers in 82.5%; 68.4% of patients with no contraindication received fibrinolysis. In no case was door-to-needle time less than 30 min, and mean time was 122 min. All patients admitted to hospitals with catheterization facilities underwent primary angioplasty; mean door-to-balloon time in these patients was 161 min; in only 28% was it less than 90 min.CONCLUSIONThe system can be used as a tool to monitor the performance of initial treatment of patients with STEMI. Analysis of these indicators in the future may help to evaluate the contribution of online reporting to the development of better treatment practices.