title: Pre-hospital ECG E-transmission for patients with suspected myocardial infarction in the highlands of Scotland.
abstract: Patients with ST elevation myocardial infarction (STEMI) require prompt treatment, best done by primary percutaneous coronary intervention (PPCI). However, for patients unable to receive PPCI, immediate pre-hospital thrombolysis (PHT) is the best alternative. Evidence indicates that diagnostic and management support for staff increases the use of PHT. This study aimed to describe the patient demographics and management of patients, to determine any potential inter-area differences in referral rates to the ECG e-transmission service and to explore the views and experiences of key staff involved in ECG e-transmission within NHS Highland. Data from 2,025 patient episodes of ECG e-transmission identified a statistically significant geographical variation in ECG e-transmission and PHT delivery. Scottish Ambulance Service (SAS) staff were more likely than GPs to deliver PHT overall, however, GPs were more likely to deliver in remote areas. Interviews with six Cardiac Care Unit (CCU) nurses and six SAS staff highlighted their positive views of ECG e-transmission, citing perceived benefits to patients and interprofessional relationships. Poor access to network signal was noted to be a barrier to engaging in the system. This study has demonstrated that a specialist triage service based on e-transmission of ECGs in patients with suspected STEMI can be implemented in a diverse geographical setting. Work is needed to ensure equity of the service for all patients.
authors.affiliation: Highland Clinical Research Facility, Centre for Health Science, Old Perth Road, Inverness IV2 3JH, UK. gordon.rushworth@nhs.net.
authors.forename: Gordon F
authors.initials: GF
authors.lastname: Rushworth
authors.affiliation: Cardiac Unit, Raigmore Hospital, Old Perth Road, Inverness IV2 3UJ, UK. charles.bloe@nhs.net.
authors.forename: Charlie
authors.initials: C
authors.lastname: Bloe
authors.affiliation: School of Pharmacy and Life Sciences, Robert Gordon University, Riverside East, Garthdee Road, Aberdeen AB10 7GJ, UK. h.l.diack@rgu.ac.uk.
authors.forename: H Lesley
authors.initials: HL
authors.lastname: Diack
authors.affiliation: School of Pharmacy and Life Sciences, Robert Gordon University, Riverside East, Garthdee Road, Aberdeen AB10 7GJ, UK. r.reilly1@rgu.ac.uk.
authors.forename: Rachel
authors.initials: R
authors.lastname: Reilly
authors.affiliation: School of Pharmacy and Life Sciences, Robert Gordon University, Riverside East, Garthdee Road, Aberdeen AB10 7GJ, UK. calummurray14@hotmail.co.uk.
authors.forename: Calum
authors.initials: C
authors.lastname: Murray
authors.affiliation: School of Pharmacy and Life Sciences, Robert Gordon University, Riverside East, Garthdee Road, Aberdeen AB10 7GJ, UK. d.stewart@rgu.ac.uk.
authors.forename: Derek
authors.initials: D
authors.lastname: Stewart
authors.affiliation: Cardiac Unit, Raigmore Hospital, Old Perth Road, Inverness IV2 3UJ, UK. stephen.leslie@nhs.net.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Leslie
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000188:drug therapy; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012424:Rural Population; D012606:Scotland; D017216:Telemedicine; D015912:Thrombolytic Therapy