Reducing thrombolytic therapy time delays in the emergency department

A 1 year (1995) retrospective audit of all patients who were discharged or died, with a primary diagnosis of acute myocardial infarction (AMI) was conducted at Auburn Hospital, a level 4 district hospital in Sydney's western suburbs. After their first echocardiogram (ECG), 21 patients of 129 patients who had a primary diagnosis of AMI in the Emergency Department at this time were given thrombolytic therapy. For eight patients there was a time delay of over 60 min to commencement of thrombolytic therapy. This time delay exceeded the Australian Council of Health-care Standards guidelines and was targeted as a quality improvement activity. The hospital cardiologist convened meetings of medical and nursing staff, to develop an action plan for reducing these delays. The strategies adopted, implemented between April and September 1996, involved (i) keeping the ECG machine in the emergency department at all times, (ii) installing a facsimile machine, (iii) keeping Alteplase (rt-PA) in the emergency department, (iv) staff education, (v) allowing senior medical staff to initiate treatment if the consultant was not readily contactable. Resulting from these initiatives time delays (after first ECG) were reduced from a median time of 55 min in 1995 to a median time delay of 43 min in 1997. This study highlights areas of unnecessary delay in patients receiving thrombolytic therapy and shows that these delays can be reduced by the implementation of relatively simple strategies by medical and nursing staff. Time delays from the development of symptoms (usually chest pain) to arrival at triage were recorded when such a time was specified in the clinical notes. The median delay from the development of chest pain to triage was 73 min.