ORIGINAL ARTICLE

Nurse initiated thrombolysis in the accident and emergency department: safe, accurate, and faster than fast track

S M Heath, R J I Bain, A Andrews, S Chida, S I Kitchen, M I Walters

Department of Accident and Emergency, Northern Lincolnshire and Goole Hospitals NHS Trust, UK

Correspondence to:
Correspondence to:
Dr S Chida, 1A Charles Avenue, Grimsby DN33 2DA, UK;
sanjeed{at}lineone.net

Objective: To reduce the time between arrival at hospital of a patient with acute myocardial infarction and administration of thrombolytic therapy (door to needle time) by the introduction of nurse initiated thrombolysis in the accident and emergency department.

Methods: Two acute chest pain nurse specialists (ACPNS) based in A&E for 62.5 hours of the week were responsible for initiating thrombolysis in the A&E department. The service reverts to a "fast track" system outside of these hours, with the on call medical team prescribing thrombolysis on the coronary care unit. Prospectively gathered data were analysed for a nine month period and a head to head comparison made between the mean and median door to needle times for both systems of thrombolysis delivery.

Results: Data from 91 patients were analysed; 43 (47%) were thrombolysed in A&E by the ACPNS and 48 (53%) were thrombolysed in the coronary care unit by the on call medical team. The ACPNS achieved a median door to needle time of 23 minutes (IQR=17 to 32) compared with 56 minutes (IQR=34 to 79.5) for the fast track. The proportion of patients thrombolysed in 30 minutes by the ACPNS and fast track system was 72% (31 of 43) and 21% (10 of 48) respectively (difference=51%, 95% confidence intervals 34% to 69%, p<0.05).

Conclusion: Diagnosis of acute myocardial infarction and administration of thrombolysis by experienced cardiology nurses in A&E is a safe and effective strategy for reducing door to needle times, even when compared with a conventional fast track system.

Keywords: acute chest pain nurse specialists; thrombolysis; door to needle time

Abbreviations: STEMI, ST segment elevation myocardial infarction; ACPNS, acute chest pain nurse specialist; PGDs, patient group directions

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