title: Hospital delays and problems with thrombolytic administration in patients receiving thrombolytic therapy: a multicenter prospective assessment. Virginia Thrombolytic Study Group.
abstract: OBJECTIVE
  To assess the timing of key decisions and clinical events in the treatment of acute myocardial infarction with thrombolytic therapy.
  
  
  METHODS
  Prospective study of emergency department patients.
  
  
  METHODS
  EDs in 11 urban and two rural hospitals.
  
  
  METHODS
  Patients with presumed acute myocardial infarction for whom a decision was made in the ED to administer thrombolytic therapy.
  
  
  RESULTS
  Statistical analyses included determination of frequency of response, cross tabulation analysis, and Wilcoxon rank sum tests. In 210 thrombolytic-treated patients (mean age, 57 +/- 14.1 years), a median time of 155 minutes elapsed between pain onset and therapy; 67% of the delay was pre-ED arrival. The median time between ED arrival and the initial ECG was six minutes. The median time required for physicians to make a treatment decision was 20 minutes, followed by another median time of 20 minutes for staff to begin drug infusion. The median total hospital (door-to-needle) time was 50 minutes. Significantly shorter delays occurred in urban, teaching, and high-volume hospitals; when thrombolytics were stocked and/or started in the ED; and when emergency physicians treated without involving private attending physicians. Although 95% of patients received tissue plasminogen activator, six patients treated with anisoylated plasminogen-streptokinase activator complex experienced a significantly faster door-to-needle time (P less than .05).
  
  
  CONCLUSIONS
  Thrombolytics should be stocked and started in the ED. Emergency physicians should generally make the decision to administer thrombolytic therapy with reference to accepted protocols without awaiting an ED consultation from either private attendings or cardiologists.
authors.affiliation: Department of Pharmacy and Pharmaceutics, School of Pharmacy, Virginia Commonwealth University, Richmond.
authors.forename: E R
authors.initials: ER
authors.lastname: Gonzalez
authors.forename: L A
authors.initials: LA
authors.lastname: Jones
authors.forename: J P
authors.initials: JP
authors.lastname: Ornato
authors.forename: G C
authors.initials: GC
authors.lastname: Bleecker
authors.forename: M J
authors.initials: MJ
authors.lastname: Strauss
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016255:Anistreplase / Q000627:therapeutic use; D003657:Decision Making; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D011446:Prospective Studies; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014768:Virginia
chemical_list: D016255:Anistreplase; D010959:Tissue Plasminogen Activator