title: Reducing call-to-needle times: the critical role of pre-hospital thrombolysis.
abstract: BACKGROUND
  Current guidelines recommend that patients with acute myocardial infarction should receive thrombolysis within 60 min of seeking professional help.
  
  
  OBJECTIVE
  To compare current rates of pre-hospital thrombolysis in Grampian with historical data, and assess the effect of pre-hospital thrombolysis on the proportion of patients achieving 'call-to-needle' times within national guidelines.
  
  
  METHODS
  Prospective audit.
  
  
  METHODS
  Data were collected on all patients (n=535) admitted to the coronary care unit and thrombolysed, either in hospital or in the community from July 2000 to June 2002, using standardized forms.
  
  
  RESULTS
  One hundred and thirty-three patients (25%) received pre-hospital thrombolysis and 402 (75%) received in-hospital thrombolysis. This compares with a 19% (195/1046) pre-hospital thrombolysis rate in the mid-1990s (p=0.005). Median 'call-to-needle' times were 45 min for pre-hospital thrombolysis and 105 min for patients who received in-hospital thrombolysis (p < 0.001). Only 24% (96/396) of patients receiving in-hospital thrombolysis were treated within the recommended guideline, vs. 79% (88/111) of pre-hospital thrombolysis patients (p <0.001).
  
  
  CONCLUSIONS
  Pre-hospital thrombolysis rates in Grampian are increasing. Administration of thrombolysis in the community greatly increases the proportion of patients achieving a 'call-to-needle' time of 60 min, with a median time saving of approximately 1 h.
authors.affiliation: Cardiac Research Department, Aberdeen Royal Infirmary, Aberdeen, AB25 2ZN.
authors.forename: J A L
authors.initials: JA
authors.lastname: Smith
authors.forename: K P
authors.initials: KP
authors.lastname: Jennings
authors.forename: E A
authors.initials: EA
authors.lastname: Anderson
authors.forename: P
authors.initials: P
authors.lastname: Green
authors.forename: G S
authors.initials: GS
authors.lastname: Hillis
mesh_terms: D000208:Acute Disease; D000368:Aged; D004638:Emergency Treatment / Q000379:methods / Q000639:trends; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy*; D009206:Myocardium / Q000378:metabolism; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012423:Rural Health; D012606:Scotland; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D019210:Troponin I / Q000032:analysis
chemical_list: D019210:Troponin I