Emergency department thrombolysis critical pathway reduces door-to-drug times in acute myocardial infarction

Background: Rapid time to treatment with thrombolytic therapy is an importa nt determinant of survival in acute myocardial infarction (AMI). Hypothesis: We hypothesized that establishment of an AMI thrombolysis criti cal pathway in the Emergency Department could successfully reduce the "door -to-drug" time, the time between patient arrival and start of thrombolysis. Methods and results: Before establishment of the AMI critical pathway, medi an door-to-drug time was 73 min, which was reduced to 37 min after critical pathway implementation (p < 0.05). The percentage of patients treated with in 30 min rose from 0% prior to establishment of the pathway to 43% (p = 0. 03). Similarly, the percentage treated in within 45 min rose from 0 to 67% (p = 0.0005). Door-to-drug times were longer for women than for men (median 105 min for women vs. 70 min for men before pathway implementation). The p athway reduced door-to-drug time for both genders, but the median door-to-d rug times were higher for women than for men (Mann-Whitney p = 0.013). The difference between men and women was 35 min before establishment of the pat hway to 10 min by the end of the study period. Conclusions: Our critical pathway was successful in reducing door-to-drug t imes. We observed a "gender gap" in door-to-drug times, with longer mean ti mes for women, which was reduced by the AMI critical pathway. Thus, our dat a provide support for the use of critical pathways to reduce door-to-drug t imes, as recommended by the National Heart Attack Alert Program.