Does initiation of an ambulance pre-alert call reduce the door to needle time in acute myocardial infarct?

Abstract

Objectives: To assess the effect an ambulance pre-alert call for patients with suspected acute myocardial infarction (AMI) would have on door to needle (DTN) times. Methods: We carried out back to back audits of DTN times following the initiation of the pre-alert calls. Participants: All patients thrombolysed within the emergency department between July 2003 and April 2004 (inclusive). Statistical analysis: Mean DTN times and time to ECG pre-change and post-change were compared using the Two sample t test. The Fisher's exact test was used to compare pre-change and post-change proportions of patients seen within guideline times. Results: In total, 73 patients were thrombolysed with 40 of these arriving by ambulance. Eighteen of these 40 were pre-change and 22 were post-change. Four patients were excluded. Fifty per cent of the prechange group had a DTN time of ,30 minutes compared with 91% of the post-change group (p = 0.005, Fisher's exact test). The phase one mean DTN time was found to be significantly greater than that for phase two (Two sample t test, p = 0.016; 95% CI 1.6 to 14.6).Conclusions: There was a significant reduction in DTN times after the introduction of the pre-alert call. S everal randomised controlled trials have shown that morbidity and mortality associated with acute myocardial infarction (AMI) can be reduced by early thrombolysis.

Pain to Hospital Times After Myocardial Infarction in Patients from Dalmatian Mainland and Islands, Southern Croatia

“…In many European countries and the US, assistance to myocardial infarction patients is prompt and efficient in urban areas and areas outside cities with plenty accessible roads, but less so in remote rural areas (38)(39)(40). In our study, patients were rarely admitted to hospital within 90-minute even if they were from the city: only 9.1% of city patients were admitted to the CCU within the recommended time.…”

Exclusive bed for thrombolysis. A simple measure that allows 85% of ischemic stroke patients to be treated in the first hour

“…The relation between reduction in time to treatment and better outcomes had been previously demonstrated in other diseases as myocardial infarction, trauma and sepsis 11,12,13,14 . In the last decade this was also considered in stroke, but only 26% of patients have the opportunity to receive IVT in the first hour after arrival 2 .…”

Quality of the handover of patient care: A comparison of Pre-Hospital and Emergency Department notes

“…This information can then be assimilated into the triage, patient assessment and subsequent treatment ( Hatton, 2005). The importance of an accurate and timely handover from pre-hospital crews has been recognised in a number of situations, particularly in the resuscitation room (Nolan and Parr, 1997), with the pre-alerting of an ED decreasing the time to treatment of myocardial infarction patients (Learmonth et al, 2006). When Brown and Bleetman (2006) reviewed those patients the ED had been pre-alerted to, 23 of the 27 patients were critically ill. Of the 52 critically ill patients brought to the department, only 29 had been pre-alerted.…”