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Effect of "fast track" admission for acute myocardial infarction on delay to thrombolysis
A C Pell1, H C Miller, C E Robertson
1Department of Cardiology, Royal Infirmary, Edinburgh.
Insights
A fast track triage system significantly reduced delays in treatment for acute myocardial infarction patients. This system halved in-hospital delays for thrombolytic therapy without compromising diagnostic accuracy.
Area of Science:
- Cardiology
- Emergency Medicine
- Healthcare Systems Analysis
Background:
- Acute myocardial infarction (AMI) requires rapid intervention to minimize myocardial damage.
- Delays in treatment, particularly thrombolytic therapy, are associated with poorer patient outcomes.
- Efficient patient triage in emergency settings is crucial for timely AMI management.
Purpose of the Study:
- To evaluate the effectiveness of a fast track triage system in reducing treatment delays for patients with acute myocardial infarction.
- To assess the impact of the fast track system on the accuracy of diagnosis for AMI patients.
Main Methods:
- A comparative study was conducted before and after the implementation of a fast track triage system.
- Patients with suspected acute myocardial infarction were rapidly assessed, bypassing initial registrar evaluation.
- Data on admission delays and time to thrombolytic treatment were collected and analyzed.
Main Results:
- The fast track system correctly identified 62% of patients requiring thrombolytic treatment.
- Median delay from hospital admission to thrombolytic treatment decreased from 93 minutes to 49 minutes (p < 0.001).
- In-hospital delay for cardiac care unit admission was reduced by 47% for fast track patients.
Conclusions:
- The implemented fast track system effectively halved in-hospital delays for thrombolytic treatment in AMI patients.
- The system achieved significant time reductions without negatively impacting diagnostic accuracy.
- The fast track triage model requires no additional staff or equipment, offering a cost-effective solution.
Objective:
To evaluate the impact of a fast track triage system for patients with acute myocardial infarction.
Design:
Comparison of delays in admission to hospital and in receiving thrombolytic treatment before and after introducing fast track system with delays recorded in 1987-8. Patients fulfilling clinical and electrocardiographic criteria for myocardial infarction were selected for rapid access to the cardiac care team, bypassing evaluation by the medical registrar.
Setting:
Major accident and emergency, cardiac and trauma centre.
Subjects:
359 patients admitted to the cardiac care unit during 1 February to 31 July 1990 with suspected acute infarction.
Main Outcome Measures:
Accuracy of diagnosis and delay from arrival at hospital to thrombolytic treatment.
Results:
248 of the 359 patients had myocardial infarction confirmed, of whom 127 received thrombolytic treatment. The fast track system correctly identified 79 out of 127 (62%) patients who subsequently required thrombolytic treatment. 95% (79/83) of patients treated with thrombolysis after fast track admission had the diagnosis confirmed by electrocardiography and enzyme analysis. The median delay from hospital admission to thrombolytic treatment fell from 93 minutes in 1987-8 to 49 minutes in fast track patients (p less than 0.001). Delay in admission to the cardiac care unit was reduced by 47% for fast tract patients (median 60 minutes in 1987-8 v 32 minutes in 1990, p less than 0.001) and by 25% for all patients (60 minutes v 45 minutes, p less than 0.001).
Conclusion:
This fast track system requires no additional staff or equipment, and it halves inhospital delay to thrombolytic treatment without affecting the accuracy of diagnosis among patients requiring thrombolysis.