Fast track thrombolysis in acute myocardial infarction: a quality improvement project

Thrombolytic therapy for acute myocardial infarction has been proved to be most effective if given very early in the course of evolving infarction. This study was undertaken to optimise such treatment by overcoming the in-hospital delay in the existing set-up of an industrial hospital. A quality improvement project was undertaken to analyse the existing system of thrombolysing 46 consecutive patients of acute myocardial infarction treated in six months. By following the breakthrough sequence and proceeding in steps, the causes for delay in door to needle time were identified and rectified over two months. Impact of such measures in 32 patients of acute myocardial infarction thrombolysed consecutively in the next five months was studied. Door to needle time in the baseline group (n = 46) was in the range of 15-145 minutes and the average was 48.9 minutes. Only 32.6 percent of the patients in this group were thrombolysed within 30 minutes of arrival in the hospital. After the corrective measures were implemented in a study group of 32 patients, 27 with clear indication on admission were thrombolysed on the fast track i.e. with minimum delay. Five patients with doubtful need were put on the slow track and subsequently thrombolysed. Patients with no indication or a contra-indication for thrombolysis were excluded from this study. In the fast group, door to needle time reduced to an average of 22.56 minutes with a range of 7 to 67 minutes and 75 percent of the thrombolysed patients received the infusion within 30 minutes of arrival in the hospital. Differences in door to needle time between the two groups were statistically significant. Streamlining the hospital systems and procedures can help reduce the door to needle time in thrombolysing patients of acute myocardial infarction. This could be achieved within the existing resources by applying the principles of total quality improvement.