Abstract
Objective: To reduce the time between arrival at hospital of a patient with acute myocardial infarction and administration of thrombolytic therapy (door to needle time) by the introduction of nurse initiated thrombolysis in the accident and emergency department.
Methods: Two acute chest pain nurse specialists (ACPNS) based in A&E for 62.5 hours of the week were responsible for initiating thrombolysis in the A&E department. The service reverts to a "fast track" system outside of these hours, with the on call medical team prescribing thrombolysis on the coronary care unit. Prospectively gathered data were analysed for a nine month period and a head to head comparison made between the mean and median door to needle times for both systems of thrombolysis delivery.
Results: Data from 91 patients were analysed; 43 (47%) were thrombolysed in A&E by the ACPNS and 48 (53%) were thrombolysed in the coronary care unit by the on call medical team. The ACPNS achieved a median door to needle time of 23 minutes (IQR=17 to 32) compared with 56 minutes (IQR=34 to 79.5) for the fast track. The proportion of patients thrombolysed in 30 minutes by the ACPNS and fast track system was 72% (31 of 43) and 21% (10 of 48) respectively (difference=51%, 95% confidence intervals 34% to 69%, p<0.05).
Conclusion: Diagnosis of acute myocardial infarction and administration of thrombolysis by experienced cardiology nurses in A&E is a safe and effective strategy for reducing door to needle times, even when compared with a conventional fast track system.
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Selected References
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- Birkhead J. S. Time delays in provision of thrombolytic treatment in six district hospitals. Joint Audit Committee of the British Cardiac Society and a Cardiology Committee of Royal College of Physicians of London. BMJ. 1992 Aug 22;305(6851):445–448. doi: 10.1136/bmj.305.6851.445. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Boersma E., Maas A. C., Deckers J. W., Simoons M. L. Early thrombolytic treatment in acute myocardial infarction: reappraisal of the golden hour. Lancet. 1996 Sep 21;348(9030):771–775. doi: 10.1016/S0140-6736(96)02514-7. [DOI] [PubMed] [Google Scholar]
- Edhouse J. A., Sakr M., Wardrope J., Morris F. P. Thrombolysis in acute myocardial infarction: the safety and efficiency of treatment in the accident and emergency department. J Accid Emerg Med. 1999 Sep;16(5):325–330. doi: 10.1136/emj.16.5.325. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Flisher D. Fast track: early thrombolysis. 1995 May 25-Jun 7Br J Nurs. 4(10):562, 564-5. doi: 10.12968/bjon.1995.4.10.562. [DOI] [PubMed] [Google Scholar]
- Hood S., Birnie D., Swan L., Hillis W. S. Questionnaire survey of thrombolytic treatment in accident and emergency departments in the United Kingdom. BMJ. 1998 Jan 24;316(7127):274–274. doi: 10.1136/bmj.316.7127.274. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kendall J. M., McCabe S. E. The use of audit to set up a thrombolysis programme in the accident and emergency department. J Accid Emerg Med. 1996 Jan;13(1):49–53. doi: 10.1136/emj.13.1.49. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Quinn T. Can nurses safely assess suitability for thrombolytic therapy? A pilot study. Intensive Crit Care Nurs. 1995 Jun;11(3):126–129. doi: 10.1016/s0964-3397(95)80605-9. [DOI] [PubMed] [Google Scholar]
- Wilmshurst P., Purchase A., Webb C., Jowett C., Quinn T. Improving door to needle times with nurse initiated thrombolysis. Heart. 2000 Sep;84(3):262–266. doi: 10.1136/heart.84.3.262. [DOI] [PMC free article] [PubMed] [Google Scholar]