Variability in thrombolytic practice in Oregon.

STUDY OBJECTIVE

To examine current thrombolytic protocols in Oregon emergency departments with regard to variations in patient evaluation, inclusion and exclusion criteria, initiation of therapy, and available thrombolytic agents.

DESIGN

Telephone survey of ED head nurses.

SETTING

All acute-care hospital EDs in Oregon.

TYPE OF PARTICIPANTS

Of 70 acute-care hospitals contacted, 67 (96%) were included: 61 (87%) have a written ED protocol for thrombolytic agent use.

METHODS

Telephone survey of written thrombolytic protocols, with comparison of groups using Kruskal-Wallis test (P less than .05).

MEASUREMENTS AND MAIN RESULTS

The primary modes of initiating thrombolytic therapy are at the emergency physician's discretion (32%). after private physician consultation (24%), through the use of an agreement developed by the emergency physicians in conjunction with cardiologists or internists (22%), or after cardiologist or internist consultation (22%). ECG interpretation before drug administration is most often performed by the emergency physician (41%), cardiologist or internist (28%), private physician (6%), or computer (10%). Both tissue plasminogen activator (tPA) and streptokinase are available at 50 hospitals (75%); tPA is used exclusively in ten (15%) and streptokinase in seven (10%) other hospitals. tPA and streptokinase are approved for ED use in 43 (72%) and 46 (81%), respectively, of the hospitals at which these agents are available. In these, the ED is the most frequent site of administration of tPA in only 28 (65%) and of streptokinase in 33 (72%) hospitals; tPA and streptokinase are kept in the ED in only 23 (53%) and 23 (50%) of these hospitals, respectively. There was a significant correlation between thrombolytic administration in the ED and the number of full-time emergency physicians and American Board of Emergency Medicine diplomates.

CONCLUSION

Thrombolytic protocols are highly variable in Oregon EDs.