title: Nurse initiated thrombolysis in the accident and emergency department: safe, accurate, and faster than fast track.
abstract: OBJECTIVE
  To reduce the time between arrival at hospital of a patient with acute myocardial infarction and administration of thrombolytic therapy (door to needle time) by the introduction of nurse initiated thrombolysis in the accident and emergency department.
  
  
  METHODS
  Two acute chest pain nurse specialists (ACPNS) based in A&E for 62.5 hours of the week were responsible for initiating thrombolysis in the A&E department. The service reverts to a "fast track" system outside of these hours, with the on call medical team prescribing thrombolysis on the coronary care unit. Prospectively gathered data were analysed for a nine month period and a head to head comparison made between the mean and median door to needle times for both systems of thrombolysis delivery.
  
  
  RESULTS
  Data from 91 patients were analysed; 43 (47%) were thrombolysed in A&E by the ACPNS and 48 (53%) were thrombolysed in the coronary care unit by the on call medical team. The ACPNS achieved a median door to needle time of 23 minutes (IQR=17 to 32) compared with 56 minutes (IQR=34 to 79.5) for the fast track. The proportion of patients thrombolysed in 30 minutes by the ACPNS and fast track system was 72% (31 of 43) and 21% (10 of 48) respectively (difference=51%, 95% confidence intervals 34% to 69%, p<0.05).
  
  
  CONCLUSIONS
  Diagnosis of acute myocardial infarction and administration of thrombolysis by experienced cardiology nurses in A&E is a safe and effective strategy for reducing door to needle times, even when compared with a conventional fast track system.
authors.affiliation: Department of Accident and Emergency, Northern Lincolnshire and Goole Hospitals NHS Trust, UK. sanjeed@lineone.net
authors.forename: S M
authors.initials: SM
authors.lastname: Heath
authors.forename: R J I
authors.initials: RJ
authors.lastname: Bain
authors.forename: A
authors.initials: A
authors.lastname: Andrews
authors.forename: S
authors.initials: S
authors.lastname: Chida
authors.forename: S I
authors.initials: SI
authors.lastname: Kitchen
authors.forename: M I
authors.initials: MI
authors.lastname: Walters
mesh_terms: D004636:Emergency Service, Hospital / Q000592:standards*; D006801:Humans; D009203:Myocardial Infarction / Q000451:nursing*; D015397:Program Evaluation; D011446:Prospective Studies; D015912:Thrombolytic Therapy / Q000451:nursing* / Q000592:standards; D013997:Time Factors