Can nurses safely assess suitability for thrombolytic therapy? A pilot study.

Thrombolytic therapy reduces mortality in patients with acute myocardial infarction. Early treatment is crucial and any system which reduces 'door-to-needle' time without placing the patient at risk is to be encouraged. A group of 20 patients with suspected heart attack was assessed by coronary care nurses and preregistration house officers with regard to: time of symptom onset; admission 12 lead electrocardiogram, presence of contraindications to thrombolytic therapy. Nurses and house officers were asked to state whether or not they considered thrombolysis indicated, and if so, which agent they would recommend on an 'intention to treat' basis. Participating staff were given the option of referral for senior medical opinion. There was no difference in nurses' and house officers' stated intentions regarding thrombolytic therapy. A group of 46 patients was assessed by nurses alone on an 'intention to treat' basis; in this latter group nurses' management intentions were identical to those of the responsible doctor prescribing treatment. Appropriately trained nurses can assess patients with suspected heart attack accurately and safely for thrombolytic therapy. In practice, this could reduce delays to thrombolysis and merits further scrutiny.