Efficacy of fibrinolysis in the emergency department for acute myocardial infarction.
BACKGROUND
Patients with an acute myocardial infarction require a rapid response to their symptoms and the earlier fibrinolysis is given (where indicated), the better the outcome.


OBJECTIVE
The aim of this study is to compare 'door to needle times' for fibrinolysis in Acute Myocardial Infarction (AMI) in three phases of one year each, at Letterkenny General Hospital.


METHODS
In the PREINTERVENTION year all fibrinolysis was performed in the Coronary Care Unit (CCU). In the INTERVENTION year Emergency Department (ED) fast track fibrinolysis was introduced and in the POST INTERVENTION year most fibrinolysis was performed on fast track in the ED.


RESULTS
The time saved by the introduction of ED fibrinolysis was significant, 41 minutes on average per patient. Elderly, female patients were more likely to bypass ED fast track fibrinolysis and to be brought to CCU for fibrinolysis, with attendant delays. This has educational implications in relation to the variation in clinical presentation of AMI with age and sex.


CONCLUSIONS
The ED fast track fibrinolysis system is recommended as an effective, safe, achievable and worthwhile intervention towards improving 'door to needle times' for fibrinolysis in AMI.
Lane
G
G
Emergency Dept, Letterkenny General Hospital.
Cuddihy
J
J
Wright
P
P
Doherty
D
D
McShane
A
A
D000208:Acute Disease; D000368:Aged; D003325:Coronary Care Units / Q000592:standards*; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007494:Ireland; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000592:standards / Q000706:statistics & numerical data*; D013997:Time Factors; D013996:Time and Motion Studies
D005343:Fibrinolytic Agents