Impact of a region-wide approach to improving systems for heart attack care: the West Midlands thrombolysis project.
OBJECTIVE
To describe changes in delay to administration of thrombolytic therapy associated with a region-wide audit.


METHODS
Observational study of patients admitted with suspected myocardial infarction (MI) based on continuous audit.


METHODS
18877 patients admitted to 23 hospitals with suspected MI between April 1995 and March 1998.


RESULTS
Of 11232 patients with a discharge diagnosis of definite MI, 8802 (46.6%) received thrombolytic therapy during hospitalisation, with 5155 patients eligible for treatment on admission to hospital on the basis of established indications. Call-to-needle time for those eligible for treatment on admission fell from median 105 min in the first year of the project to 85 min in year 3 (P<0.001), and door-to-needle time fell from 45 to 35 min (P<0.001). Forty percent of eligible patients were treated within the then current national standard of 90 min from time of call for help, with nearly 49% in the final year and 20% being treated within the new national standard of 60 min, by the third year.


CONCLUSIONS
The proportion of eligible patients receiving thrombolysis within 1 h of the call for help doubled during the 3-year project but the majority of patients still wait longer than 60-min 'call-to-needle'. New systems to reduce delays to administration of thrombolysis to within 60 min of call for help are required, including consideration of pre-hospital treatment.
Quinn
Tom
T
NHS Executive, West Midlands, Birmingham, UK. t.quinn@coventry.ac.uk
Allan
Teresa F
TF
Birkhead
John
J
Griffiths
Rod
R
Gyde
Sylvia
S
Gordon Murray
R
R
D000368:Aged; D000704:Analysis of Variance; D003325:Coronary Care Units; D004632:Emergency Medical Services / Q000592:standards; D004638:Emergency Treatment / Q000592:standards; D004739:England; D019983:Guideline Adherence / Q000592:standards; D006302:Health Services Research; D006801:Humans; D008485:Medical Audit; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D012041:Regional Medical Programs / Q000458:organization & administration*; D015912:Thrombolytic Therapy / Q000592:standards*; D013997:Time Factors; D013996:Time and Motion Studies; D017749:Total Quality Management / Q000458:organization & administration*