Thrombolytic therapy in Missouri hospital emergency departments: compliance with the National Heart Attack Alert Program guidelines.

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.