Challenges in Implementation of Institutional Protocols for Patients With Acute Coronary Syndrome

The diagnosis of acute coronary syndrome (ACS) encompasses ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation ACS (non-STEMI and unstable angina). In recent years, there have been improvements in the rates of death, cardiogenic shock, and recurrent myocardial infarction in patients with ACS, primarily due to the introduction of new pharmacological and interventional therapies, as well as the introduction of and adherence to new treatment guidelines. However, ACS still represents a considerable public health burden. Treatment recommendations for STEMI and non-ST-segment elevation differ and there is wide variation in practice patterns and adherence among and within hospitals especially for the latter diagnosis. Adoption of institutional protocols may help decrease variability and improve quality of care, efficiency, and, ultimately, patient outcomes. This report discusses the process of developing and implementing institutional protocols for patients with ACS, from initial medical contact to discharge and beyond.