title: Determining patients' suitability for thrombolysis: coronary care nurses' agreement with an expert cardiological 'gold standard' as assessed by clinical and electrocardiographic 'vignettes'.
abstract: BACKGROUND
  Thrombolytic therapy is an established treatment for acute myocardial infarction, the benefits of which are time-dependent. Coronary care nurses are often the first professionals to assess patients with suspected myocardial infarction on hospital admission, and there are a number of reports of nurseled practices for immediate assessment and 'cardiac triage'.
  
  
  OBJECTIVE
  To assess coronary care nurses' ability to determine patients' suitability for thrombolysis as judged by an expert cardiological 'gold standard'.
  
  
  METHODS
  Ten coronary care units in the Northern and Yorkshire region of England were sent packs comprising 10 sets of 10 'vignettes' and accompanying electrocardiograms together with a questionnaire regarding treatment decisions. An expert 'gold standard' for correct responses to the questionnaire was derived following independent assessment of the vignettes by three nurse specialists and three consultant cardiologists. Respondents' treatment decisions were subsequently compared with the 'gold standard'.
  
  
  RESULTS
  Of 42 (42%) completed sets of questionnaires returned for analysis, 37 (87%) of respondents indicated management decisions in absolute agreement with the 'gold standard'. Where there was not absolute agreement, most treatment decisions were acceptable as safe practice.
  
  
  CONCLUSIONS
  The majority of nurses indicated safe and appropriate management decisions. These limited data provide further support for ongoing developments of nurse-initiated thrombolysis, although there is a need for further, larger trials to determine the safety and efficacy of such an approach to patient care.
authors.affiliation: Department of Cardiology, Freeman Hospital, Newcastle-upon-Tyne, UK.
authors.forename: T
authors.initials: T
authors.lastname: Quinn
authors.forename: A
authors.initials: A
authors.lastname: MacDermott
authors.forename: J
authors.initials: J
authors.lastname: Caunt
mesh_terms: D002309:Cardiology / Q000592:standards; D002983:Clinical Competence / Q000592:standards; D003325:Coronary Care Units; D004562:Electrocardiography; D006801:Humans; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000188:drug therapy* / Q000451:nursing*; D009730:Nursing Assessment / Q000592:standards*; D015403:Nursing Evaluation Research; D009741:Nursing Staff, Hospital / Q000592:standards*; D018579:Patient Selection; D013041:Specialties, Nursing; D011795:Surveys and Questionnaires; D015912:Thrombolytic Therapy / Q000451:nursing*