Call‐to‐needle times for thrombolysis in acute myocardial infarction in Victoria

Kelly, Anne‐Maree; Kerr, Debra; Patrick, Ian; Walker, Tony

doi:10.5694/j.1326-5377.2003.tb05255.x

Cited by 29 publications

(25 citation statements)

References 23 publications

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“…[13][14][15] However, it has consistently been shown that ambulance transport rates for patients with AMI are low (45-73%). 6 [16][17][18] Several studies have tried to determine why patients with AMI do not use ambulance transport (non-ambulance participants). 7 17 18 They report the main problems as patient's belief that the symptoms are not severe enough to warrant calling for an ambulance, and believing that self-transport will be quicker.…”

mentioning

confidence: 99%

Predictors of ambulance use in patients with acute myocardial infarction in Australia

Kerr

Holden

Smith

et al. 2006

Emergency Medicine Journal

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mentioning

confidence: 99%

Predictors of ambulance use in patients with acute myocardial infarction in Australia

Kerr

Holden

Smith

et al. 2006

Emergency Medicine Journal

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“…3 Simply knowing that an intervention might reduce time delay is not sufficient to justify the potential costs of implementation. Before introducing any of these interventions we need to know whether the potential benefit is likely to justify the costs.…”

Section: Discussionmentioning

confidence: 99%

“…3 Observational data were collected from 20 hospitals and two ambulance services over a 30 month period for all patients arriving at hospital by ambulance who received thrombolysis. The data collected represent the vast majority of eligible patients in Victoria.…”

Section: Methodsmentioning

confidence: 99%

“…3 A number of interventions have been suggested to reduce such delays. These include ambulance pre-notification of receiving hospitals, 4 thrombolysis in the emergency department (ED) rather than the coronary care unit (CCU), 5 prehospital thrombolysis, 6 bypass of rural hospitals if they are unable to deliver thrombolysis, and advising patients to call directly for an ambulance rather than their GP if they experience chest pain.…”

mentioning

confidence: 99%

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Potential impact of interventions to reduce times to thrombolysis

Goodacre

Kelly²,

Kerr³

2004

Emergency Medicine Journal

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Objectives: To estimate the lifesaving potential of interventions to accelerate the administration of intravenous thrombolysis for myocardial infarction. Methods: Data were analysed from a prospective, observational study of all patients transported to hospital by ambulance, who subsequently received intravenous thrombolysis at 20 hospitals and two ambulance services in Victoria, Australia (n = 1147). Regression models estimated the association between predictor variables age, sex, route of referral, symptom onset to call time, ambulance pre-notification of the receiving hospital, emergency department thrombolysis, and the outcome, time to thrombolysis. Further modelling estimated the number needed to treat to save one life by several recommended interventions to reduce time delays. Results: Presentation via a rural hospital or general practitioner was associated with an approximate doubling of the onset to call time (2.08 and 2.30 respectively). Ambulance-hospital pre-notification and emergency department thrombolysis reduced door to needle times by 21% and 27% respectively. Modelling showed that each of the following interventions would be expected to save one life: 1069 hospital pre-notifications, 714 cases of emergency department thrombolysis, 184 cases of prehospital thrombolysis, 340 cases to bypass their rural hospital, or 50 cases to bypass their general practitioner. Conclusions: Hospital pre-notification and emergency department thrombolysis reduce time delays, although the mortality impact seems to be modest. Prehospital thrombolysis has the potential to save lives, although validation in real practice is required. Advising patients to call directly for an ambulance, rather than the general practitioner, has the greatest potential to save lives.

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“…This clinical target comes after consideration and adoption of the British Heart Foundation's recommendation that door-to-needle times of 30 minutes are achievable in 80% of patients in rural communities 20. To achieve our project goals and review quality improvement progress, we utilised international guidelines to form a gold-standard thrombolysis management framework and collected data at 6 monthly intervals over a 12 month period (i.e.…”

Section: Baseline Measurementmentioning

confidence: 99%

Improving door-to-needle times for patients presenting with ST-elevation myocardial infarction at a rural district general hospital

Jordan¹,

Caesar²

2016

BMJ Qual Improv Report

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Acute coronary syndrome is a common condition with a major global impact on healthcare resources and expenditure. International guidelines are clear in specifying that patients with acute ST-elevation myocardial infarction (STEMI) should receive urgent coronary reperfusion with either primary percutaneous coronary intervention (PCI) or thrombolysis. Although PCI is the gold standard in the treatment of STEMI, this is not always achievable in a rural hospital with no cardiac catheterization service. Consequently, local recommendations on STEMI management exist to promote timely administration of thrombolysis within 30 minutes of patient arrival. However, translating updated clinical policy into practice is a challenging and complex task that requires a multi-faceted approach with sustained engagement from local stakeholders.Whilst working at a district general hospital in New Zealand, we noted a high incidence of patients presenting with STEMI receiving thrombolytic therapy outside the recommended 30 minutes door-to-needle time. Although final treatment was often only delayed by 5-10 minutes, we were concerned by the seemingly inconsistent management of these patients, often leading to unnecessary delays in the initiation of rapid reperfusion therapy.We therefore championed a newly updated clinical guideline and promoted an early STEMI recognition and treatment algorithm in our hospital to raise awareness amongst staff and improve door-to-needle times. We introduced a number of simple low-cost interventions that included educational sessions for junior doctors and cardiac nursing staff, as well as posters and training on the use of a remote electronic ECG interpretation system to streamline out-of-hours management.Overall, we found there to a be a steady improvement in door-to-needle times at our hospital, with 74% of patients receiving appropriate care within 30 minutes, compared to 43% prior to our interventions. This also translated to better patient outcomes.This project forms part of an ongoing process to instigate quality improvements in the management of STEMI within rural institutions. Whilst we have demonstrated improved utilisation of a local STEMI guideline and streamlining of out-of-hours services, the key challenge remains to ensure that momentum of this project continues and forms a platform for sustainable clinical improvement in the long term.

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Call‐to‐needle times for thrombolysis in acute myocardial infarction in Victoria

Cited by 29 publications

References 23 publications

Predictors of ambulance use in patients with acute myocardial infarction in Australia

Predictors of ambulance use in patients with acute myocardial infarction in Australia

Potential impact of interventions to reduce times to thrombolysis

Improving door-to-needle times for patients presenting with ST-elevation myocardial infarction at a rural district general hospital

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