A door-to-needle time of 30 minutes or less for myocardial infarction thrombolysis is possible in rural emergency departments.
OBJECTIVE
The Canadian Emergency Cardiac Care Coalition, the American Heart Association and similar groups have established a benchmark for the administration of thrombolytics in acute myocardial infarction (AMI) care as a door-to-needle (DTN) time of 30 minutes or less. Previous research suggests that this goal is not being achieved in Canada. The purpose of this study was to determine whether the target DTN time of 30 minutes or less for thrombolysis could be met in 2 rural Ontario emergency departments (EDs).


METHODS
We conducted a retrospective chart review and obtained descriptive data for each case, including demographic information and the Canadian Emergency Department Triage and Acuity Scale (CTAS) score. Visit timeline data were also collected and included the time during which patients saw a physician, had an electrocardiogram (ECG), received thrombolytic therapy and were discharged from the ED. Relevant time intervals, such as the median DTN time, were calculated.


RESULTS
A total of 454 charts were reviewed for patients with a diagnosis of AMI who were seen between 1996 and 2007. The final sample consisted of 101 patients who received thrombolytics (63% men) whose median age was 67 years and median CTAS score was Level II (Emergent). The median door-to-ECG time was 6 minutes, door-to-physician time was 8 minutes and DTN time was 27 minutes; 58% of patients received thrombolytics within 30 minutes.


CONCLUSIONS
A DTN time of 30 minutes or less is achievable in rural EDs.
Vlahaki
Dean
D
University of Queensland, Brisbane, Australia.
Fiaani
Majed
M
Milne
William Ken
WK
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004562:Electrocardiography; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006780:Hospitals, Rural / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D009864:Ontario; D010351:Patient Discharge / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015912:Thrombolytic Therapy; D013997:Time Factors; D013996:Time and Motion Studies