OBJECTIVES: To determine whether a specialist cardiac nurse would improve delay to thrombolysis in acute myocardial infarction (MI). SUBJECTS: Patients presenting with chest pain to a district general hospital. METHOD: Comparison of: a) door-to-needle times of patients with 'definite' MI when the nurse was on and off duty (15 months) and prior to her employment (3 months); b) pain-to-needle times for definite MI; and c) door-to-needle times of patients without definite MI on first electrocardiogram (ECG) but who subsequently qualified for thrombolysis. RESULTS: Of 365 patients included in the study, 289 had definite MI. Before the appointment of a thrombolysis nurse, door-to-needle times were 0% at 30 minutes, 7% at 45 minutes and 34% at 60 minutes. Since the appointment, with the nurse on-duty, they have improved to 58%, 91% and 100% respectively, a saving of 36 minutes in median door-to-needle time (p = 0.0001). There was a median saving of 95 minutes in pain-to-needle times with the thrombolysis nurse on duty compared with off duty (p = 0.0001). Finally, with the nurse on duty there was also a saving of 36 minutes in median door-to-needle time in patients in whom the first ECG was non-diagnostic for MI (p = 0.02). CONCLUSIONS: A thrombolysis nurse produced a dramatic improvement in median door-to-needle and pain-to-needle times in patients presenting with definite MI. This would lead to an additional 41 lives saved at 30 months per 1,000 patients treated. With 24-hour thrombolysis nurse cover, this would potentially lead to 8 additional lives saved at 30 months at a cost of 12,300 Pounds each. There was also a striking improvement in door-to-needle times for patients presenting with a non-diagnostic first ECG who subsequently qualified for thrombolysis.
OBJECTIVES: To determine whether a specialist cardiac nurse would improve delay to thrombolysis in acute myocardial infarction (MI). SUBJECTS:Patients presenting with chest pain to a district general hospital. METHOD: Comparison of: a) door-to-needle times of patients with 'definite' MI when the nurse was on and off duty (15 months) and prior to her employment (3 months); b) pain-to-needle times for definite MI; and c) door-to-needle times of patients without definite MI on first electrocardiogram (ECG) but who subsequently qualified for thrombolysis. RESULTS: Of 365 patients included in the study, 289 had definite MI. Before the appointment of a thrombolysis nurse, door-to-needle times were 0% at 30 minutes, 7% at 45 minutes and 34% at 60 minutes. Since the appointment, with the nurse on-duty, they have improved to 58%, 91% and 100% respectively, a saving of 36 minutes in median door-to-needle time (p = 0.0001). There was a median saving of 95 minutes in pain-to-needle times with the thrombolysis nurse on duty compared with off duty (p = 0.0001). Finally, with the nurse on duty there was also a saving of 36 minutes in median door-to-needle time in patients in whom the first ECG was non-diagnostic for MI (p = 0.02). CONCLUSIONS: A thrombolysis nurse produced a dramatic improvement in median door-to-needle and pain-to-needle times in patients presenting with definite MI. This would lead to an additional 41 lives saved at 30 months per 1,000 patients treated. With 24-hour thrombolysis nurse cover, this would potentially lead to 8 additional lives saved at 30 months at a cost of 12,300 Pounds each. There was also a striking improvement in door-to-needle times for patients presenting with a non-diagnostic first ECG who subsequently qualified for thrombolysis.
Authors: Kelly A McDermott; Christian D Helfrich; Anne E Sales; John S Rumsfeld; P Michael Ho; Stephan D Fihn Journal: J Gen Intern Med Date: 2008-05-06 Impact factor: 5.128