USE OF FAX FACILITY IMPROVES DECISION-MAKING REGARDING THROMBOLYSIS IN ACUTE MYOCARDIAL-INFARCTION

Background-Electrocardiography is the fundamental investigation for de cision making regarding thrombolytic treatment in acute myocardial inf arction (MI). Increasing the accuracy of ECG analysis by input from co nsultant staff may assist in management decisions in patients with sus pected MI. Aims-To evaluate a system whereby out of hours ECGs can be fared to the consultant to aid in decision making regarding thrombolyt ic treatment. Methods-112 patients with suspected MI were assessed on admission by the senior house officer (SHO) who fared to a cardiology consultant the ECG trace and a predesigned form with information on: c linical assessment of the patient; interpretation of the ECG; and view s regarding administration of thrombolytic treatment including choice of agent. The consultant reviewed the information and communicated his views to the SHO. Subsequent diagnosis was recorded in all patients a nd the forms were analysed in regard to areas of agreement and disagre ement between the SHO and the consultant. Results-A diagnosis of MI wa s confirmed in 52 of the 112 patients (46.4%). The consultant agreed w ith the SHO's decision on thrombolysis in 98 patients (87.5%). The rea son for disagreement in the remaining 14 patients (12.5%) was SHO misi nterpretation of the ECG (10 patients) and clinical assessment (four p atients). Eight patients were saved unnecessary thrombolytic treatment and four received it when they otherwise would not have. Additionally the choice of thrombolytic agent was changed in six patients from str eptokinase to tissue plasminogen activator. Conclusion-The use of a fa x machine assists in decision making with regard to thrombolytic treat ment and provides support to junior doctors in what can be a difficult , yet critical decision.