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European Heart Journal 1990 11(Supplement F):48-52; doi:10.1093/eurheartj/11.suppl_F.48
Copyright © 1990 by the European Society of Cardiology.
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© 1990 The European Society of Cardiology

Reduction in hospital time to thrombolytic therapy by audit of policy guidelines

A. G. MacCallum, P. J. Stafford, C. Jones, R. Vincent, C. Perez-Avila and D. A. Chamberlain

Department of Cardiology, Royal Sussex Country Hospital Brighton, U. K.

Correspondence to: Dr DA Chamberlain, Department of Cardiology, Royal Sussex County Hospital, Eastern Road, Brighton BN2 5BE, U.K.

Despite the importance of early thrombolysis in the treatment of acute myocardial infarction, unacceptable delays in drug administration still occur in hospital. From March 1989 we decided to monitor our performance, and thereby to reduce avoidable in-hospital delay to a minimum. Potential candidates for thrombolytic therapy were identified by paramedic ambulancemen whenever this was feasible. Rapld check-lists were used for inclusion and exclusion criteria in the Accident and Emergency Department. A target of 15 min was set for time to treatment, and reasons for any gross deviation (>30 min) were explored in each instance. As a result of these strategies, we achieved a median time from admission to initiation of thrombolysis in 50 consecutive patients of 17 min. The 39 patients treated with injections of APSAC nr opposed to infusions of streptokinase had a median in-hospital delay to treatment of only 13 min.

Key Words: Delay • thrombolytic therapy • check-lists


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A. J. Doorey, E. L. Michelson, and E. J. Topol
Thrombolytic Therapy of Acute Myocardial Infarction: Keeping the Unfulfilled Promises
JAMA, December 2, 1992; 268(21): 3108 - 3114.
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