Evaluation of the Monash Health Suspected MI pathway.

In Feb 2022 Monash Health introduced a new suspected MI pathway. Patients follow one of four streams depending on pre-hospital symptom duration/onset, baseline and serial hs-cTnI levels. These are the rapid rule-out (RRO) group, the rapid rule-in (RRI) group the 0/1-hour serial group and the 0/1/3-hour serial group. It is important for pathway maintenance and improvement to monitor both the numbers of patients proceeding through each arm, pathway compliance within each arm, reasons for non-compliance when this occurs and patient outcome within each arm. Stage 1 is development of a QA ethics application to collect data on pathway compliance for all pathway streams (RRO, RRI, 0/1-hour serial, 0/1/3 serial). Once complete will identify main areas of pathway non-compliance. Note: This is expected to be taking place at the Victorian Heart Hospital, a new Monash Health hospital which is planned to open in February 2023. Stage 2 is (a) development of a questionnaire about barriers to pathway compliance for attending staff. Will require preceding research on questionnaire development and following of the identified steps to develop the tool; (b) ethics application for a staff survey. Stage 3: Conduct of staff survey, analysis of results. Following this, development of an intervention to improve compliance based on the survey findings. Ethics submission for a pre and post-intervention QA audit to evaluate the intervention. Stage 4: Continuation/completion of CQI project evaluation (depending on numbers). Analysis of results – numbers through each stream, pathway compliance and compliance barriers. Development of potential interventions to address identified barriers to pathway compliance. Stage 5: Evaluation of patient outcomes from each pathway stream. In this stage, 30-day follow-up information will be gathered, analyzed and reported for each patient stream. Performance of this will be included in the original study protocol approved by ethics but will not have been part of investigator duties in the previous stages. Note: The 2023 project is expected to finish at this point. Stage 6+: Finalization of interventions to improve pathway compliance and/or to revise pathway sections depending on patient outcomes in particular streams. Ethics submission to study eventual impact of interventions. Conduct of audit to evaluate effect of interventions. Note – This will not be part of the 2023 project for time reasons.