Thrombolysis in acute myocardial infarction: reducing in hospital treatment delay.

AIM

Thrombolytic treatment when given early in acute myocardial infarction is beneficial. This study was initiated to firstly, document the existing time delays in the administration of thrombolysis at Auckland Hospital, and secondly, prospectively assess the effect of a staff education programme to reduce in-hospital delay. The goal was a "door to needle time" of less than 30 minutes.

METHODS

The time delays in the administration of thrombolysis to patients with acute myocardial infarction admitted to the coronary care unit at Auckland Hospital were established. This was done with a retrospective chart review over a six month period January to June 1993. This was followed by a staff education programme to fast track the management of patients eligible for thrombolysis. A prospective assessment was performed from February to May 1994 to audit the effectiveness of the programme.

RESULTS

Most of the delay in the administration of thrombolysis occurred in the community prior to arrival at hospital (median delay 2.5 hours). However there was still a significant delay in hospital with a median door to needle time of 59 minutes in 1993. Following the education programme in 1994 the median door to needle time was reduced by 32% to 40 minutes (p = 0.03). The proportion of patients with a door to needle time of less than 30 minutes doubled from 13% in 1993 to 27% in 1994 (p = 0.18).

CONCLUSION

Staff training and thrombolysis guidelines are effective in reducing in-hospital treatment delay but additional strategies may be warranted. Thrombolysis should be administered in the coronary care unit or emergency department to avoid delay. Ongoing assessment of standards will be required in the general hospital setting as a quality indicator.