Steele M T, Hansen J W, Watson W
Mo Med. 1998 Apr;95(4):179-83.
A self-administered questionnaire concerning the current practice of thrombolytic administration, and the use of National Heart Attack Alert Program (NHAAP) guidelines was mailed to the medical directors of Missouri acute care emergency departments (EDs). Responses from 75% of the EDs surveyed were received. There were standing orders to perform an electrocardiogram at 92% of the EDs surveyed. Thrombolytics were stocked in 80% of EDs and thrombolytics were administered in the ED rather than the ICU or CCU at 98%. The emergency physician (EP) was authorized to make thrombolytic treatment decisions at 87% of the institutions; however, in 24% of the hospitals EPs were required to contact another physician prior to giving thrombolytics. An Acute Myocardial Infarction (AMI) Continuous Quality Improvement (CQI) program was in place at 67%, and 44% of the institutions had an interdepartmental AMI protocol. Less than half of the EDs reported a door-to-drug time of less than 30 minutes. The primary delay in starting thrombolytic therapy was identified as decision-making on the part of the emergency physician and/or consultants. Missouri EDs report that they generally follow the NHAAP guidelines for rapid identification and treatment of AMI, but, there were still significant delays reported in the administration of thrombolytics.
一份关于当前溶栓治疗实践以及国家心脏病发作警报计划（NHAAP）指南使用情况的自填式问卷被邮寄给了密苏里州急诊部门（ED）的医疗主任。收到了75%被调查急诊部门的回复。92%被调查的急诊部门有执行心电图检查的常规医嘱。80%的急诊部门备有溶栓药物，98%的急诊部门在急诊室而非重症监护病房（ICU）或冠心病监护病房（CCU）进行溶栓治疗。87%的机构授权急诊医生（EP）做出溶栓治疗决策；然而，在24%的医院，急诊医生在给予溶栓药物之前需要联系另一位医生。67%的机构实施了急性心肌梗死（AMI）持续质量改进（CQI）计划，44%的机构有部门间AMI协议。不到一半的急诊部门报告门到用药时间少于30分钟。启动溶栓治疗的主要延迟被确定为急诊医生和/或会诊医生的决策过程。密苏里州的急诊部门报告称，他们通常遵循NHAAP指南对AMI进行快速识别和治疗，但是，在溶栓治疗的实施方面仍报告存在显著延迟。
