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Thrombolysis in acute myocardial infarction: reducing in hospital treatment delay.
N Z Med J. 1995 Jun 28; 108(1002):253-4.NZ

Abstract

AIM

Thrombolytic treatment when given early in acute myocardial infarction is beneficial. This study was initiated to firstly, document the existing time delays in the administration of thrombolysis at Auckland Hospital, and secondly, prospectively assess the effect of a staff education programme to reduce in-hospital delay. The goal was a "door to needle time" of less than 30 minutes.

METHODS

The time delays in the administration of thrombolysis to patients with acute myocardial infarction admitted to the coronary care unit at Auckland Hospital were established. This was done with a retrospective chart review over a six month period January to June 1993. This was followed by a staff education programme to fast track the management of patients eligible for thrombolysis. A prospective assessment was performed from February to May 1994 to audit the effectiveness of the programme.

RESULTS

Most of the delay in the administration of thrombolysis occurred in the community prior to arrival at hospital (median delay 2.5 hours). However there was still a significant delay in hospital with a median door to needle time of 59 minutes in 1993. Following the education programme in 1994 the median door to needle time was reduced by 32% to 40 minutes (p = 0.03). The proportion of patients with a door to needle time of less than 30 minutes doubled from 13% in 1993 to 27% in 1994 (p = 0.18).

CONCLUSION

Staff training and thrombolysis guidelines are effective in reducing in-hospital treatment delay but additional strategies may be warranted. Thrombolysis should be administered in the coronary care unit or emergency department to avoid delay. Ongoing assessment of standards will be required in the general hospital setting as a quality indicator.

Authors+Show Affiliations

Department of Medicine, Auckland Hospital.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

7617332

Citation

Porter, G, et al. "Thrombolysis in Acute Myocardial Infarction: Reducing in Hospital Treatment Delay." The New Zealand Medical Journal, vol. 108, no. 1002, 1995, pp. 253-4.
Porter G, Doughty R, Gamble G, et al. Thrombolysis in acute myocardial infarction: reducing in hospital treatment delay. N Z Med J. 1995;108(1002):253-4.
Porter, G., Doughty, R., Gamble, G., & Sharpe, N. (1995). Thrombolysis in acute myocardial infarction: reducing in hospital treatment delay. The New Zealand Medical Journal, 108(1002), 253-4.
Porter G, et al. Thrombolysis in Acute Myocardial Infarction: Reducing in Hospital Treatment Delay. N Z Med J. 1995 Jun 28;108(1002):253-4. PubMed PMID: 7617332.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Thrombolysis in acute myocardial infarction: reducing in hospital treatment delay. AU - Porter,G, AU - Doughty,R, AU - Gamble,G, AU - Sharpe,N, PY - 1995/6/28/pubmed PY - 1995/6/28/medline PY - 1995/6/28/entrez SP - 253 EP - 4 JF - The New Zealand medical journal JO - N Z Med J VL - 108 IS - 1002 N2 - AIM: Thrombolytic treatment when given early in acute myocardial infarction is beneficial. This study was initiated to firstly, document the existing time delays in the administration of thrombolysis at Auckland Hospital, and secondly, prospectively assess the effect of a staff education programme to reduce in-hospital delay. The goal was a "door to needle time" of less than 30 minutes. METHODS: The time delays in the administration of thrombolysis to patients with acute myocardial infarction admitted to the coronary care unit at Auckland Hospital were established. This was done with a retrospective chart review over a six month period January to June 1993. This was followed by a staff education programme to fast track the management of patients eligible for thrombolysis. A prospective assessment was performed from February to May 1994 to audit the effectiveness of the programme. RESULTS: Most of the delay in the administration of thrombolysis occurred in the community prior to arrival at hospital (median delay 2.5 hours). However there was still a significant delay in hospital with a median door to needle time of 59 minutes in 1993. Following the education programme in 1994 the median door to needle time was reduced by 32% to 40 minutes (p = 0.03). The proportion of patients with a door to needle time of less than 30 minutes doubled from 13% in 1993 to 27% in 1994 (p = 0.18). CONCLUSION: Staff training and thrombolysis guidelines are effective in reducing in-hospital treatment delay but additional strategies may be warranted. Thrombolysis should be administered in the coronary care unit or emergency department to avoid delay. Ongoing assessment of standards will be required in the general hospital setting as a quality indicator. SN - 0028-8446 UR - https://www.unboundmedicine.com/medline/citation/7617332/Thrombolysis_in_acute_myocardial_infarction:_reducing_in_hospital_treatment_delay_ L2 - https://medlineplus.gov/heartattack.html DB - PRIME DP - Unbound Medicine ER -