Katherine
Congratulations on being made a National Clinical
Leader in this important area! I echo your views that
management of acute coronary syndromes should be seen
as a core function of Emergency Medicine.
Undifferentiated chest pain presenting to the ED is a
substantial proportion of our workload (about 5,000
patients /100,000 seen at the LGI).....about the same
number as ankle injuries...which of course we
(doctors)don't seem to see any more ;-)
Having good processes to pull out those requiring time
critical interventions should be a critical issue for
us all and the NSF is certainly helping to deliver on
this.
Leeds was one of the pilot sites for the MINAP
database run by the RCP and we certainly had some
issues about what qualified a patient to be in the
denominator group to be included in the 75% target
within 30 mins. This has been clarified a lot. The
Leeds Trust is presently sitting on 70% within 30mins
which for 2 large dept (combined seeing 195,000 new
patients) is not bad. The model is an ED doctor and
nurse delivered decision making process with protocol
and EP senior support. We do not use thrombolysis
nurses (expensive option :-) but do have a senior 'ACS
nurse' who helps link with coronary care, provides
education etc. We still fall down when things get too
busy or those who come in with atypical symptoms.
The more concerning problem of course is meeting the
call-to-needle time targets....ours are very
poor......to embarassing to publish here!!!!!
We do however have an RCT presently running of
pre-hosp ECG vs no ECG ( the PACE study - Paramedic
Assessment of Cardiac Emergencies) and hope that this
will give us an insight into tackling this problem
with our pre-hospital colleagues. It hopefully will
also act as a step towards focused education for the
long term plan - pre-hospital thrombolysis in obvious
MI...which is very much on the DoH's agenda.
Sorry....this was meant to be a short email......the
question IS..."What are other people's experience of
the 'call to needle' time problem Katherine..or
others"
Thanks
Taj
=====
Dr Taj Hassan
Consultant in Emergency Medicine
Dept of Emergency Medicine
Leeds General Infirmary
Leeds LS1 3EX, UK
Work email: [log in to unmask]
Tel : (0113) 392 6470 Fax : (0113) 392 2810
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