Nurse initiated thrombolysis in the accident and emergency department: safe, accurate, and faster than fast track

• Published in: Emergency medicine journal : EMJ Vol. 20; no. 5; pp. 418 - 420
• Main Authors: Heath, S M, Bain, R J I, Andrews, A, Chida, S, Kitchen, S I, Walters, M I
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine 01-09-2003; BMJ Publishing Group Ltd; BMJ Publishing Group LTD; BMJ Group
• Subjects: ACPNS; acute chest pain nurse specialist; acute chest pain nurse specialists; Acute coronary syndromes; Audits; Cardiology; Cardiovascular disease; Care and treatment; Confidence intervals; Diana, Princess of Wales; door to needle time; Emergency Service, Hospital - standards; Heart attack; Heart attacks; Hospitals; Humans; Mortality; Myocardial Infarction - nursing; National service; Nurses; Original; patient group directions; PGDs; Program Evaluation; Prospective Studies; ST segment elevation myocardial infarction; STEMI; thrombolysis; Thrombolytic Therapy - nursing; Thrombolytic Therapy - standards; Time Factors; United Kingdom > UK
• ISSN: 1472-0205; 1472-0213
• DOI: 10.1136/emj.20.5.418

Objective: To reduce the time between arrival at hospital of a patient with acute myocardial infarction and administration of thrombolytic therapy (door to needle time) by the introduction of nurse initiated thrombolysis in the accident and emergency department. Methods: Two acute chest pain nurse specialists (ACPNS) based in A&E for 62.5 hours of the week were responsible for initiating thrombolysis in the A&E department. The service reverts to a “fast track” system outside of these hours, with the on call medical team prescribing thrombolysis on the coronary care unit. Prospectively gathered data were analysed for a nine month period and a head to head comparison made between the mean and median door to needle times for both systems of thrombolysis delivery. Results: Data from 91 patients were analysed; 43 (47%) were thrombolysed in A&E by the ACPNS and 48 (53%) were thrombolysed in the coronary care unit by the on call medical team. The ACPNS achieved a median door to needle time of 23 minutes (IQR=17 to 32) compared with 56 minutes (IQR=34 to 79.5) for the fast track. The proportion of patients thrombolysed in 30 minutes by the ACPNS and fast track system was 72% (31 of 43) and 21% (10 of 48) respectively (difference=51%, 95% confidence intervals 34% to 69%, p<0.05). Conclusion: Diagnosis of acute myocardial infarction and administration of thrombolysis by experienced cardiology nurses in A&E is a safe and effective strategy for reducing door to needle times, even when compared with a conventional fast track system.