Article Text


Original research article
Multicentre analysis of current ST-elevation myocardial infarction acute care pathways
  1. Joppe Tra1,
  2. Carolien de Blok2,
  3. Ineke van der Wulp1,
  4. Martine C de Bruijne1 and
  5. Cordula Wagner1,3
  1. 1Department of Occupational and Public Health, EMGO+/VU University Medical Center, Amsterdam, The Netherlands
  2. 2Faculty of Economics and Business, Department of Operations, University of Groningen, Groningen, The Netherlands
  3. 3The Netherlands Institute of Health Services Research (NIVEL), Utrecht, The Netherlands
  1. Correspondence to Joppe Tra; joppetra{at}


Background Rapid reperfusion with percutaneous coronary intervention (PCI) is vital for patients with ST segment elevation myocardial infarction (STEMI). However, the guideline-recommended time targets are regularly exceeded. The goal of this study was to gain insight into how Dutch PCI centres try to achieve these time targets by comparing their care processes with one another and with the European guideline-recommended process. In addition, accelerating factors perceived by care providers were identified.

Methods In this multiple case study, interviews with STEMI care providers were conducted, transcribed and used to create process descriptions per centre. Analyses consisted of within-case and between-case analyses of the processes. Accelerating factors were identified by means of open and axial coding.

Results In total, 28 interviews were conducted in six PCI centres. The centres differed from the guideline-recommended process on, for example, additional, unavoidable patient routings and monitoring delays, and from one another on the communication of diagnostic information (eg, transmitting all, only ambiguous or no ECGs) and catheterisation room preparation. These differences indicated diverging choices to maintain a balance between speed and diagnostic accuracy. Factors perceived by care providers as accelerating the process included trust in the tentative diagnosis, and avoiding unnecessary intercaregiver consultations. The combination of processes and accelerating factors were summarised in a model.

Conclusions Numerous differences in processes between PCI centres were identified. Several time-saving strategies were applied by PCI centres, however, in different configurations. To further improve the care for patients with STEMI, best practices can be shared between centres and countries.

Statistics from

  • Received July 27, 2016.
  • Revision received November 23, 2016.
  • Accepted December 20, 2016.
View Full Text


  • Contributors JT designed the study; collected, analysed and interpreted the data; and wrote the initial draft of the paper. MCdB and IvdW helped analyse and interpret the data and revised subsequent versions of the paper. MCdB and CW helped design the study and revised subsequent versions of the paper.

  • Funding This work was supported by the Dutch Ministry of Health, Welfare and Sport.

  • Competing interests None declared.

  • Ethics approval Medical Ethical Committee of the VU University Medical Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.