Hospitals improve on "door to needle" time
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《英国医生杂志》
More than three quarters of patients having a heart attack are given thrombolytic drugs within 30 minutes of reaching a hospital, according to results from an audit of hospitals in England and Wales published last week.
The third public report of the Myocardial Infarction National Audit Project (MINAP)—a regular audit assessing the care of patients taken to hospital after a myocardial infarction—showed that most hospitals were now reaching the "30-minute door-to-needle" goal for giving patients thrombolytic drugs.
When the project started, in 2000, few hospitals reached the goal that 75% of eligible patients should receive thrombolytic drugs within 30 minutes of arriving at hospital. In the first six months of 2001, fewer than 50% of patients received treatment in 30 minutes. However, new data for the first three months of 2004 showed sustained improvement, with a national average of 81% of patients achieving the 30 minute thrombolysis goal. The percentage of hospitals achieving the "door to needle" goal had increased from 47.8% in the previous report for the year April 2002-March 2003 to 77.3% in the latest audit.
The new figures showed that nearly half of patients (49%) were reaching the more stringent "call to needle time" target of 60 minutes, in which a patient is given thrombolysis within 60 minutes of the initial call for professional help. From a baseline of 38% of patients receiving thrombolytic drugs within 60 minutes of the first call in December 2002, the Department of Health was aiming to see a 10% increase each year, making the target for this year 48%.
Mr Don MacKechnie, consultant in emergency medicine at Rochdale Infirmary and chairman of the accident and emergency subcommittee of the BMA抯 Central Consultants and Specialists Committee, said: "Good teamwork within A and E departments and with ambulance services is essential to achieve prompt thrombolysis. Simple protocols are also required to ensure all staff are clear about the need for early ECG and the provision of thrombolytics to appropriate patients presenting with chest pain."
Mr MacKechnie noted that Rochdale Infirmary had achieved the best "call to needle" times in the country—85% of patients receiving thrombolysis within 60 minutes of a first call—by organising a system in which ambulance staff called the accident and emergency department to give advance warning of patients with suspected myocardial infarction and applied electrocardiography stickers to patients?chests before hospital arrival. The accident and emergency department had taken responsibility for managing all patients presenting with chest pain, rather than some being seen by medical on call teams. A thrombolysis nurse had also been appointed to train all nursing staff and facilitate prompt provision of thrombolysis.
The national audit was first developed to show how hospitals were performing against goals in the national service framework for coronary heart disease, a 10 year programme published by the Department of Health in March 2000 to improve prevention, diagnosis, and treatment. It was carried out by the Royal College of Physician抯 Clinical Effectiveness and Evaluation Unit working in collaboration with the Central Cardiac Audit Database and funded by the Healthcare Commission.
The national clinical director for heart disease, Dr Roger Boyle, commented on the national audit figures: "Continuing to deliver an annual improvement will be challenging. Further progress on the 60 minute target will depend on giving thrombolysis pre-hospital. The introduction of paramedic-led pre-hospital services hold the key to ensuring that every heart attack patient receives optimal treatment."
Further figures in the audit showed that nearly all hospitals were now meeting the goals for prescribing drugs to reduce the risk of another myocardial infarction—that 80-90% of patients discharged from hospital after a myocardial infarction should be given aspirin, b blockers, or statins. National averages showed that 97% of such patients were given aspirin on discharge, 89% were given b blockers, and 93% were given statins.(London Susan Mayor)
The third public report of the Myocardial Infarction National Audit Project (MINAP)—a regular audit assessing the care of patients taken to hospital after a myocardial infarction—showed that most hospitals were now reaching the "30-minute door-to-needle" goal for giving patients thrombolytic drugs.
When the project started, in 2000, few hospitals reached the goal that 75% of eligible patients should receive thrombolytic drugs within 30 minutes of arriving at hospital. In the first six months of 2001, fewer than 50% of patients received treatment in 30 minutes. However, new data for the first three months of 2004 showed sustained improvement, with a national average of 81% of patients achieving the 30 minute thrombolysis goal. The percentage of hospitals achieving the "door to needle" goal had increased from 47.8% in the previous report for the year April 2002-March 2003 to 77.3% in the latest audit.
The new figures showed that nearly half of patients (49%) were reaching the more stringent "call to needle time" target of 60 minutes, in which a patient is given thrombolysis within 60 minutes of the initial call for professional help. From a baseline of 38% of patients receiving thrombolytic drugs within 60 minutes of the first call in December 2002, the Department of Health was aiming to see a 10% increase each year, making the target for this year 48%.
Mr Don MacKechnie, consultant in emergency medicine at Rochdale Infirmary and chairman of the accident and emergency subcommittee of the BMA抯 Central Consultants and Specialists Committee, said: "Good teamwork within A and E departments and with ambulance services is essential to achieve prompt thrombolysis. Simple protocols are also required to ensure all staff are clear about the need for early ECG and the provision of thrombolytics to appropriate patients presenting with chest pain."
Mr MacKechnie noted that Rochdale Infirmary had achieved the best "call to needle" times in the country—85% of patients receiving thrombolysis within 60 minutes of a first call—by organising a system in which ambulance staff called the accident and emergency department to give advance warning of patients with suspected myocardial infarction and applied electrocardiography stickers to patients?chests before hospital arrival. The accident and emergency department had taken responsibility for managing all patients presenting with chest pain, rather than some being seen by medical on call teams. A thrombolysis nurse had also been appointed to train all nursing staff and facilitate prompt provision of thrombolysis.
The national audit was first developed to show how hospitals were performing against goals in the national service framework for coronary heart disease, a 10 year programme published by the Department of Health in March 2000 to improve prevention, diagnosis, and treatment. It was carried out by the Royal College of Physician抯 Clinical Effectiveness and Evaluation Unit working in collaboration with the Central Cardiac Audit Database and funded by the Healthcare Commission.
The national clinical director for heart disease, Dr Roger Boyle, commented on the national audit figures: "Continuing to deliver an annual improvement will be challenging. Further progress on the 60 minute target will depend on giving thrombolysis pre-hospital. The introduction of paramedic-led pre-hospital services hold the key to ensuring that every heart attack patient receives optimal treatment."
Further figures in the audit showed that nearly all hospitals were now meeting the goals for prescribing drugs to reduce the risk of another myocardial infarction—that 80-90% of patients discharged from hospital after a myocardial infarction should be given aspirin, b blockers, or statins. National averages showed that 97% of such patients were given aspirin on discharge, 89% were given b blockers, and 93% were given statins.(London Susan Mayor)