1. Quality Improvement Initiatives

2. National Service Framework for Coronary Heart Disease-UK Cooperative Cardiovascular Project (CCP)-USA National Registry of Myocardial Infarction (NRMI)-US Berlin Myocardial Infarction Registry-Germany

3. Quality Improvement Initiatives Global Registry of Acute Coronary Events (GRACE) Improving Cardiovascular Outcomes in Nova Scotia (ICONS)-Canada Alberta Provincial Project for Outcome Assessment in Coronary heart Disease database (APPROACH)-Canada Enhanced Feedback for Effective Cardiac Treatment (EFFECT)-Canada

5. 0 20 30 40 Teaching Hospital Community Hospital Small Hospital Time (minutes) Door-to-Needle time for thrombolytic therapy Benchmark  30 min 38 min37 min 40 min Ontario average = 37 min 12/44 hospitals met benchmark EFFECT STUDY

6. Type of physician caring for heart attack patients 0 20 40 60 80 100 Percent Cardiologist General Internist Family Physician 32% 34% 30% EFFECT STUDY 4% are Other

7. Door-to-Needle Time  Was 11 minutes less when Emergency physician made decision to administer thrombolytic therapy  Was 10 minutes less when thrombolytic therapy was administered in Emergency Department rather than in CCU/ICU