The Potential impact of Patient self Referral on Mortality in Acute Myocardial Infarction

How do patients with chest pain access Emergency Department care?

“…In 62% of cases, the delay for patients in arriving at the ED was more than 3 h. This results from the complex process of decision-making after the onset of chest pain, including cognitive and emotional processes, individual beliefs and values, and the influence of the context of the event 14 .…”

Referral pattern to the allergist for hay fever in a health‐care system with open access to specialists

“…However, the continuous increase in health-care costs may favor this role in the future. Although self-referral has been advocated for specific conditions such as acute asthma or myocardial infarction (1,18,27) and open access for exercise testing encouraged (24), this cannot apply to hay fever. Over 2/3 of our patients were self-referred, but nearly all had been symptomatic for years and had been treated before, meaning that they had consulted their GP in the past.…”

“…Many self-referred patients have first seen their GP and then come for a second opinion; these patients should not be underestimated since they are as likely to be admitted (17) and may suffer from significant disorders (10). For specific health problems such as asthma and myocardial infarction, selfreferral has been shown to be appropriate when studied (1,18,27).…”

Thrombolysis in myocardial infarction

“…The current median interval between onset of pain and the start of treatment in British hospitals is three to four and a half hours 5,6. Although fast track policies can shorten the in hospital delay, another approach is to attempt prehospital thrombolysis.…”

“…In this study the median interval between prehospital and in hospital treatment was 139 minutes. Given that the median door to needle time in many hospitals is 55 to 89 minutes,5,6 these data emphasise the importance of streamlining procedures in accident and emergency departments and justify the use of thrombolytic treatment by general practitioners equipped with an electrocardiograph, particularly in rural areas where journey times to hospital exceed 30 minutes.…”