A nation divided

Corfield et al¹ demonstrate improvements in door‐to‐needle time with a relatively simple organisational change. Other examples of innovation can be found across the country.² Driving these changes in England and Wales is the National Service Framework which sets a standard of 60 minutes from calling for professional help until the initiation of thrombolysis.³ The Myocardial Infarction National Audit Project (MINAP) demonstrates the success of this approach.⁴

The only current standard which applies in Scotland is that set by Quality Improvement Scotland (QIS). This is a door‐to‐needle target of 30 minutes for the delivery of thrombolysis in the context of an acute ST elevation myocardial infarction.⁵ There is no standard set for call‐to‐needle and furthermore there is no national audit framework to monitor progress. In our own area although we achieve and exceed the current QIS target with a median door‐to‐needle time of 24 minutes for patients presenting to the Accident and Emergency department. If the National Framework target for call‐to‐needle is applied we would fail to achieve the standard by 27% (median call‐to‐needle time 76 minutes). We can see no reason why the prehospital phase of the treatment of acute myocardial infarction has been ignored by QIS. Without this as an audit standard, many departments simply do not collect the data, and the opportunity for local organisational change is lost.

If national targets are to affect the performance of the National Health Service, they need to be applied to the entire United Kingdom.