AUDIT OF PREHOSPITAL THROMBOLYSIS BY GENERAL-PRACTITIONERS IN PERIPHERAL PRACTICES IN GRAMPIAN

Background-In the Grampian region early anistreplase trial (GREAT), do miciliary thrombolysis by general practitioners was associated with a halving of one year mortality compared with hospital administration. H owever, after completion of the trial and publication of the results, the use of this treatment by general practitioners declined sharply. O bjective-To increase the proportion of eligible patients receiving tim ely thrombolytic treatment from their general practitioners. Setting-P ractices in Grampian located greater than or equal to 30 minutes' trav elling time from Aberdeen Royal Infirmary, where patients with suspect ed acute myocardial infarction were referred after being seen by gener al practitioners. Audit standard-A call-to-needle time of 90 minutes, as proposed by the British Heart Foundation (BHF). Methods-Findings of this audit of prehospital management of acute myocardial infarction w ere periodically fed back to the participating doctors, when practice case reviews were also conducted. Results-Of 414 administrations of th rombolytic treatment, 146 (35%) were given by general practitioners an d 268 (65%) were deferred until after hospital admission. Median call- to-needle times were 45 (94% less than or equal to 90) and 145 (7% les s than or equal to 90) minutes, respectively. Survival at one year was improved with prehospital compared with hospital thrombolysis (83% v 73%; p < 0.05). The proportion of patients receiving thrombolytic trea tment from their general practitioners did not increase during the aud it. Conclusions-In practices greater than or equal to 30 minutes from hospital, the BHF audit standard was readily achieved if general pract itioners gave thrombolytic treatment, but not otherwise. Knowledge of the benefits of early thrombolysis, and feedback of audit results, did not lead to increased prehospital thrombolytic use. Additional incent ives are required if general practitioners are to give thrombolytic tr eatment.