Early thrombolysis has increased survival in eligible patients with acute myocardial infarction (AMI). Therefore, early triage and short Door-To-Needle Time [DTNT, time of patient arrival in Emergency Department (ED) to time of thrombolysis] are most important. In a high volume tertiary care center (>500 beds), prompt attention to AMI patients can be delayed. Thus, we developed a Chest Pain Evaluation Program (CPEP). Prospective data on DTNT of consecutive thrombolysis treated patients prior to and after initiation of the CPEP are presented in 3 groups (GR). Pre-CPEP CPEP GR 1IN=45) GR 2(N=36) GR 3(N=36) Study Period 7/93-7/94 8/94-3/95 3/95-11/95 Median (min) 71 57 40 Range (min) 31-221 21-116 15-136 Two-Tailed P <0.03' <0.01 25,75th perc.(min) 50/98 38/73 29/58 Mann-Whitney U test; TGR1 vs GR 2; 'GR2 vs GR3; 'percentile Patients receiving thrombolysis above the 75th perc. of DTNT were considered "outliers", and observed 11x(GR1), 9x(GR2), and 9x(GR3). Causes of outliers were one or a combination of factors, as delay in 1) obtaining ECG (n=8), 2) diagnosis of AMI (n=10), and 3) decision for thrombolysis (n=23). Conclusion: CPEP has significantly decreased DTNT. Major determinants were systematic education of ED triage personnel and of responsible ED physician/nurse team, further, establishment of an in-hospital "911 system", to provide immediate cardiology service.
|Original language||English (US)|
|Journal||Journal of Investigative Medicine|
|State||Published - Jan 1 1996|
ASJC Scopus subject areas
- Biochemistry, Genetics and Molecular Biology(all)