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LETTERS: C J L Hetherington, P Doyle, J A Kayani, and D F Gorman Focus on emergency departments to reduce delays in thrombolysis BMJ 2002; 325: 901a [Full text]

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Focus on EDs to reduce delays in thrombolysis

Ian K Dukes   (23 October 2002)

Focus on EDs to reduce delays in thrombolysis 23 October 2002
Ian K Dukes, Consultant Emergency Medicine Russells Hall Hospital ,Dudley DY1 2HQ Send response to journal: Re: Focus on EDs to reduce delays in thrombolysis	I wish to register my complete agreement with Chris Hetherington and colleagues' letter. In Dudley we used to practice "fast tracking" to coronary care unit for thrombolysis in acute myocardial infarction. Up to July 2001 only 20 - 25% of eligible patients received thrombolysis within 30 minutes of arrival. In August 2001 the Emergency Department(ED) started to take responsibilty for initiating thrombolysis and by the end of 2001 this had risen to 50%. We have established a multidisciplinary thrombolysis audit review group which meets monthly and conducts root cause analysis of delays in treatment. Subsequently we have introduced a thrombolysis lead nurse, a chest pain assessment room in the ED and have started to train health care assistants to take electrocardiograms (ECGs). Our thrombolysis performance within 30 minutes of arrival was 50% in quarter 1 of 2002, 70% in quarter 2 and 89% in quarter 3( including 100% in september 2002) and 60 - 69% within 20 minutes. Acute myocardial infarction is a medical emergency; it should be treated by emergency physicians and nurses in the emergency department