Introduction In Brighton, UK, 24-h Primary Angioplasty has been used for the treatment of ST segment elevation myocardial infarction (STEMI) since October 2008, with local patients being admitted via the Accident and Emergency (A&E) department. With the publication of the National Infarct Angioplasty project report (DH 2008) it was evident that direct admission into the cardiac catheter lab from the ambulance could further reduce time to treatment. Call to Balloon time (CTBT) <150 mins is a nationally recognised indicator measuring the time the patient first calls for professional help (usually the ambulance) to the opening of the coronary artery on the catheter lab Abstract 76 table 1.
Methods The on-call cardiology team are non-resident out of hours. It was therefore agreed the point of contact and immediate decision making would lie with the Cardiac Care Unit (CCU) nurses. A pathway was developed following consultation with the multi-disciplinary team at an educational and mapping day, and risks were addressed. It was agreed that the ambulance crew would telephone the CCU nurse who would review the clinical history and the telemetry ECG. They would then make the decision to activate the catheter lab team. Patient Group Directions for the administration of GTN, diamorphine, metoclopramide and clopidogrel were developed so that immediate treatment could be delivered by the CCU nurse without medical prescription before the cardiac catheter lab team arrived, if required. The nurses were trained in their use and assessed as competent. Nurses were already competent in ECG interpretation, defibrillation, cannulation and venepuncture. Nursing documentation was developed to prioritise the patient′s emergency care. CTBT were monitored.
Results Following the implementation of the direct entry pathway in May 2010 the CTBT for all patients admitted direct to our hospital have reduced. This is statistically significant when looking at Quarter 2 results from baseline. Patient safety has not been compromised. Patients who were admitted directly have been asked about their experience and if anything could be done differently from their perspective. They have said:
The process is quick which is good from their perspective
They are fully informed
The ambulance crews deal with them competently
The lab staff are waiting for their arrival.
Conclusions The CCU nurses have embraced this development and expansion of their nursing practice, allowing major changes to be made to the Primary Angioplasty pathway within the existing infrastructure, despite the challenges of working within the complex nature of traditional geographical referral patterns. Along with the work of all members of the multi disciplinary team this has significantly reduced times to treatment for patients.
- Primary angioplasty
- expanding practice