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A door-to-needle time of 30 minutes or less for myocardial infarction thrombolysis is possible in rural emergency departments

Published online by Cambridge University Press:  21 May 2015

Dean Vlahaki ,
Majed Fiaani  and
William Ken Milne
Dean Vlahaki
Affiliation:
University of Queensland, Brisbane, Australia
Majed Fiaani
Affiliation:
Alexandra Marine and General Hospital, Goderich, Ont.
William Ken Milne*
Affiliation:
Division of Emergency Medicine, Faculty of Medicine and Dentistry, University of Western Ontario, London, Ont.
*
South Huron Hospital, 24 Huron St. W., Exeter ON N0M 1S2; monycon@hurontel.on.ca

Abstract

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Objective:

The Canadian Emergency Cardiac Care Coalition, the American Heart Association and similar groups have established a benchmark for the administration of thrombolytics in acute myocardial infarction (AMI) care as a door-to-needle (DTN) time of 30 minutes or less. Previous research suggests that this goal is not being achieved in Canada. The purpose of this study was to determine whether the target DTN time of 30 minutes or less for thrombolysis could be met in 2 rural Ontario emergency departments (EDs).

Methods:

We conducted a retrospective chart review and obtained descriptive data for each case, including demographic information and the Canadian Emergency Department Triage and Acuity Scale (CTAS) score. Visit timeline data were also collected and included the time during which patients saw a physician, had an electrocardiogram (ECG), received thrombolytic therapy and were discharged from the ED. Relevant time intervals, such as the median DTN time, were calculated.

Results:

A total of 454 charts were reviewed for patients with a diagnosis of AMI who were seen between 1996 and 2007. The final sample consisted of 101 patients who received thrombolytics (63% men) whose median age was 67 years and median CTAS score was Level II (Emergent). The median door-to-ECG time was 6 minutes, door-to-physician time was 8 minutes and DTN time was 27 minutes; 58% of patients received thrombolytics within 30 minutes.

Conclusion:

A DTN time of 30 minutes or less is achievable in rural EDs.

Keywords

myocardial infarctiondoor-to-needle timethrombolysisfibrinolysisrural
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 10 , Issue 5 , September 2008 , pp. 429 - 433
Copyright
Copyright © Canadian Association of Emergency Physicians 2008

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