title: Fibrinolytic administration for acute myocardial infarction in a tertiary ED: factors associated with an increased door-to-needle time.
abstract: The purpose of this study was to evaluate the door-to-needle time for fibrinolytic administration for acute myocardial infarction (AMI) at Vancouver General Hospital (VGH) and identify factors associated with time prolongation. A retrospective chart review of all patients fibrinolysed for AMI in the ED at VGH was performed from January 1, 1998, to December 31, 1999, to determine door-to-needle time. A mixed-effects linear regression model was fit to the fibrinolytic data with the door-to-needle time to identify factors associated with prolonged times. One hundred forty patients were included in the final analysis. The mean and median door-to-needle times were 58 and 43 minutes, respectively. A door-to-needle time of under 30 minutes was achieved in 24.3% of patients, 30 to 40 minutes in 24.3%, 40 to 60 minutes in 22.1%, and over 60 minutes in 29.3%. EP prescribers without prior cardiologist consultation resulted in a significantly shorter door-to-needle time compared with requesting a cardiology consult before administration (mean [median] 41 [35] minutes vs. 108 [90] minutes respectively; P <.001). Patients who arrived by ambulance had shorter door-to-needle times than those who did not (mean [median] 50 [38] minutes vs. 71 [57] minutes, respectively; P =.008). Patients who arrived during the night shift (2300-0700 hrs) had significantly shorter door-to-needle times than those patients who arrived during the day (0700-1500 hrs) or afternoon (1500-2300) shifts (P = 0481); and patients who had a longer time from chest pain onset to ED arrival also had longer door-to-needle times (P =.0233). A significant number of AMI patients fibrinolysed at VGH do not meet the national guideline for door-to-needle time less than 30 minutes. Factors associated with this should be addressed to improve the care of patients with AMI.
authors.affiliation: Clinical Service Unit Pharmaceutical Sciences, Vancouver General Hospital, University of British Columbia, Canada. zed@interchage.ubc.ca
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Zed
authors.forename: Riyad B
authors.initials: RB
authors.lastname: Abu-Laban
authors.forename: Travis M
authors.initials: TM
authors.lastname: Cadieu
authors.forename: Roy A
authors.initials: RA
authors.lastname: Purssell
authors.forename: Lyne
authors.initials: L
authors.lastname: Filiatrault
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001955:British Columbia; D017598:Efficiency, Organizational; D004562:Electrocardiography; D004636:Emergency Service, Hospital / Q000458:organization & administration; D004638:Emergency Treatment / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000592:standards; D006302:Health Services Research; D006769:Hospitals, General; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016014:Linear Models; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000458:organization & administration*; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome