Abstract
The purpose of this study was to evaluate the door-to-needle time for fibrinolytic
administration for acute myocardial infarction (AMI) at Vancouver General Hospital
(VGH) and identify factors associated with time prolongation. A retrospective chart
review of all patients fibrinolysed for AMI in the ED at VGH was performed from January
1, 1998, to December 31, 1999, to determine door-to-needle time. A mixed-effects linear
regression model was fit to the fibrinolytic data with the door-to-needle time to
identify factors associated with prolonged times. One hundred forty patients were
included in the final analysis. The mean and median door-to-needle times were 58 and
43 minutes, respectively. A door-to-needle time of under 30 minutes was achieved in
24.3% of patients, 30 to 40 minutes in 24.3%, 40 to 60 minutes in 22.1%, and over
60 minutes in 29.3%. EP prescribers without prior cardiologist consultation resulted
in a significantly shorter door-to-needle time compared with requesting a cardiology
consult before administration (mean [median] 41 [35] minutes vs. 108 [90] minutes
respectively; P < .001). Patients who arrived by ambulance had shorter door-to-needle times than
those who did not (mean [median] 50 [38] minutes vs. 71 [57] minutes, respectively;
P = .008). Patients who arrived during the night shift (2300–0700 hrs) had significantly
shorter door-to-needle times than those patients who arrived during the day (0700–1500
hrs) or afternoon (1500–2300) shifts (P = 0481); and patients who had a longer time from chest pain onset to ED arrival also
had longer door-to-needle times (P = .0233). A significant number of AMI patients fibrinolysed at VGH do not meet the
national guideline for door-to-needle time less than 30 minutes. Factors associated
with this should be addressed to improve the care of patients with AMI.
Keywords
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Article Info
Publication History
Accepted:
April 24,
2003
Received:
March 9,
2003
Identification
Copyright
© 2004 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
