TY - JOUR
T1 - Impact of a region-wide approach to improving systems for heart attack care
T2 - the West Midlands thrombolysis project
AU - Allan, Teresa F
AU - Birkhead, John
AU - Quinn, Tom
AU - Griffiths, Rod
AU - Gydea, Sylvia
AU - Murray, R Gordon
PY - 2003
Y1 - 2003
N2 - OBJECTIVE:
To describe changes in delay to administration of thrombolytic therapy associated with a region-wide audit.
DESIGN:
Observational study of patients admitted with suspected myocardial infarction (MI) based on continuous audit.
SUBJECTS:
18877 patients admitted to 23 hospitals with suspected MI between April 1995 and March 1998.
RESULTS:
Of 11232 patients with a discharge diagnosis of definite MI, 8802 (46.6%) received thrombolytic therapy during hospitalisation, with 5155 patients eligible for treatment on admission to hospital on the basis of established indications. Call-to-needle time for those eligible for treatment on admission fell from median 105 min in the first year of the project to 85 min in year 3 (P<0.001), and door-to-needle time fell from 45 to 35 min (P<0.001). Forty percent of eligible patients were treated within the then current national standard of 90 min from time of call for help, with nearly 49% in the final year and 20% being treated within the new national standard of 60 min, by the third year.
CONCLUSION:
The proportion of eligible patients receiving thrombolysis within 1 h of the call for help doubled during the 3-year project but the majority of patients still wait longer than 60-min 'call-to-needle'. New systems to reduce delays to administration of thrombolysis to within 60 min of call for help are required, including consideration of pre-hospital treatment.
AB - OBJECTIVE:
To describe changes in delay to administration of thrombolytic therapy associated with a region-wide audit.
DESIGN:
Observational study of patients admitted with suspected myocardial infarction (MI) based on continuous audit.
SUBJECTS:
18877 patients admitted to 23 hospitals with suspected MI between April 1995 and March 1998.
RESULTS:
Of 11232 patients with a discharge diagnosis of definite MI, 8802 (46.6%) received thrombolytic therapy during hospitalisation, with 5155 patients eligible for treatment on admission to hospital on the basis of established indications. Call-to-needle time for those eligible for treatment on admission fell from median 105 min in the first year of the project to 85 min in year 3 (P<0.001), and door-to-needle time fell from 45 to 35 min (P<0.001). Forty percent of eligible patients were treated within the then current national standard of 90 min from time of call for help, with nearly 49% in the final year and 20% being treated within the new national standard of 60 min, by the third year.
CONCLUSION:
The proportion of eligible patients receiving thrombolysis within 1 h of the call for help doubled during the 3-year project but the majority of patients still wait longer than 60-min 'call-to-needle'. New systems to reduce delays to administration of thrombolysis to within 60 min of call for help are required, including consideration of pre-hospital treatment.
KW - Health services research
UR - http://www.ncbi.nlm.nih.gov/pubmed/14622638
U2 - 10.1016/S1474-5151(03)00030-6
DO - 10.1016/S1474-5151(03)00030-6
M3 - Article
C2 - 14622638
SN - 1474-5151
VL - 2
SP - 131
EP - 139
JO - European Journal of Cardiovascular Nursing
JF - European Journal of Cardiovascular Nursing
IS - 2
ER -