FACTORS ASSOCIATED WITH DELAY IN GIVING THROMBOLYTIC THERAPY AFTER ARRIVAL AT HOSPITAL

Objective: To identify factors associated with delay in administration of thrombolytic therapy for acute myocardial infarction. Design: Retr ospective case note review of a six-month period in 1995. Data were ob tained on age, sex, hospital arrival time, triage priority, assessment process in the emergency department, grade of emergency doctor, patie nt history, timing of and findings on electrocardiogram (EGG), type of infarct, timing and site of administration of thrombolytic therapy, a nd type of thrombolysis given. Setting: Tertiary referral hospital in Newcastle, New South Wales. Participants: Eighty-five patients given t hrombolytic therapy for acute myocardial infarction. Outcome measure: Time between hospital arrival and initiation of thrombolytic therapy. Results: The median time from hospital arrival to administration of th rombolytic therapy was 80 minutes (interquartile range [IR], 50-133). Only 26% of patients were triaged to Priority 1 or 2 (to be seen by a doctor within 10 minutes). Patients initially assessed by a specialist emergency physician received thrombolytic therapy a median of 38 (IR, 33-50) minutes after hospital arrival, compared with 65 (IR, 50-107) minutes if initially assessed by a medical registrar, and 148 (IR, 89- 185) and 160 (IR, 95-163) minutes, respectively, if initially assessed by an intern or a resident medical officer (P< 0.001). Factors associ ated with increased delay in receiving thrombolytic therapy (after adj ustment for possible confounders) were low triage priority, initial as sessment by a junior doctor, atypical presenting history of myocardial infarction, and lesser degrees of ST-segment elevation on the present ing ECG (all P less than or equal to 0.01). Conclusions: Delay in admi nistration of thrombolytic therapy in hospital results from a combinat ion of hospital and patient factors. Changes in emergency department p rotocol may reduce these delays in some patients.