Cardiovascular medicine
Improving door to needle times with nurse initiated thrombolysis
P Wilmshursta, A Purchasea, C Webba, C Jowettb, T Quinnc
a Department of
Cardiology, Royal Shrewsbury Hospital, Shrewsbury SY3 8XQ, UK, b Department of Clinical Audit, c NHS Executive West Midlands, Department of
Health, Birmingham B15 3DP, UK
Correspondence to: Dr Wilmshurst
Accepted 25 April 2000
OBJECTIVE
To evaluate the effect of
nurse initiated thrombolysis on door to needle time (the interval
between arriving at the hospital and starting thrombolytic treatment)
in patients with acute myocardial infarction.
DESIGNComparison of door to needle
times before and after the employment of nurses trained and approved to
initiate thrombolysis without prescription by a doctor but with a
protocol for rapid triage of patients with chest pain.
SETTINGA district general hospital.
SUBJECTSAll patients admitted with
suspected myocardial infarction between April 1995 and March 1999.
MAIN OUTCOME MEASURESSpeed (door to
needle time) and appropriateness of administration of thrombolytic
drugs to patients with acute myocardial infarction who gave a
characteristic history and had appropriate criteria on the admission ECG.
RESULTSDuring seven periods (each of
four months) before the introduction of nurse initiated thrombolysis
and a new chest pain triage protocol, the median door to needle time
varied from 50-58 minutes. In four periods (each of 4-6 months)
following the introduction of the changes, the median door to needle
time was 25-30 minutes. The improvement was significant
(p < 0.001). Nurses trained to initiate thrombolysis currently
provide cover for 66% of the time. Median door to needle time for
nurses was 15 minutes. Median door to needle time for junior doctors
improved to 35 minutes. The median door to needle times when nurses
initiated thrombolysis was significantly shorter than when doctors
did so (p < 0.001). There have been no inappropriate management
decisions by nurses approved to initiate thrombolysis.
CONCLUSIONSThe use of nurse
initiated thrombolysis has resulted in a clinically important reduction
in the time taken for thrombolysis to be started in patients with acute
myocardial infarction.
Keywords: thrombolysis; acute myocardial infarction; door to needle time
© 2000 by Heart
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