Article Text

Download PDFPDF

Nurse initiated thrombolysis in the accident and emergency department: safe, accurate, and faster than fast track
  1. S M Heath,
  2. R J I Bain,
  3. A Andrews,
  4. S Chida,
  5. S I Kitchen,
  6. M I Walters
  1. Department of Accident and Emergency, Northern Lincolnshire and Goole Hospitals NHS Trust, UK
  1. Correspondence to:
 Dr S Chida, 1A Charles Avenue, Grimsby DN33 2DA, UK; 


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.

  • acute chest pain nurse specialists
  • thrombolysis
  • door to needle time
  • STEMI, ST segment elevation myocardial infarction
  • ACPNS, acute chest pain nurse specialist
  • PGDs, patient group directions
View Full Text

Statistics from


    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Linked Articles

    • Primary Survey
      Pete Driscoll Jim Wardope