Dear John,
In message <[log in to unmask]> "Black, John" <[log in to unmask]> writes:
> Anton,
>
> Are you advocating that this (Cath lab staffing costs for primary PTCA) is
> where limited resources should be being spent in the first instance? Should
> the provison of both strategies be mutually exclusive?
Well, there was a liberal dose of devil's advocate thrown in - just reflecting the current debate in our patch, looking at polling of resources. Both strategies certainly not mutually exclusive, esp. if combine single dose Reteplase and Gp2b/3a with direct entry/"primary" angio.
>
> Do you believe proximity (running time) to hospital should impact on whether
> prehospital thrombolysis is offered/delivered?
I used to. We drew very careful boundaries within which we do not thrombolyse and just run to hospital on blues. Subsequently, we've become more interested in urban pre-hosp thrombolysis - some of our rural pre-hosp thromblysis patients have had PAIN to needle of under 45 minutes - with aborted MIs as a result, and am wondering whether this can be done in urban settings as well.
>
> Do you believe there is a will amoungst cardiologists both locally and
> nationally to deliver primary PTCA 24/7?
I certainly don't know the national sentiment, but much interest locally in setting up some form of on-call cath suite, designated receiving, and rotating between the hospitals. Certainly still at the conceptual stage, as some hospitals do not have cath suites and there are issuesa round recurrent costs.
Anton
Staffs
>
> John Black
>
> -----Original Message-----
> From: [log in to unmask]
> [mailto:[log in to unmask]]
> Sent: 15 October 2002 12:56
> To: [log in to unmask]
> Subject: Re: Hurry up there get a move on!!!![Scanned]
>
>
> Dear Katherine,
>
> Some good discussion about urban pre-hosp thrombolysis in EMJ, so won't
> regurg that, suffice to say that there is some evid to suggest that where
> hosp systems can't achieve Door to Needle in 20 minutes, we need to consider
> pre-hosp thrombolysis.
>
> I think there is a separate debate about whether we would prefer more
> resources put into cath labs with 24 hours primary PTCA capability rather
> than into pre-hosp thrombolysis or reducing Door to Needle times. And if we
> go down the primary PTCA route, whether we should be administering a single
> dose of eg. Reteplase pre-PTCA together with Gp2b/3a.
>
> Anton
> Staffs
>
> In message <005701c273c7$76a4e780$0d210a0a@ntw852> Katherine Henderson
> <[log in to unmask]> writes:
> > Dear all,
> >
> > There is a DOH review of the 20 minute target underway. I am /will be
> > involved in it as part the CHD Collaborative National team along with the
> > CHD Collaborative Clinical Lead, Judith Fisher with a pre hospital slant,
> > Douglas Chamberlain as a grand old man of Cardiology, Tom Quinn as DOH CCU
> /
> > nursing angle. The review is being led by Joe Carver who also works for
> the
> > CHD Collaborative. The feeling so far is that the 20 minute target may
> not
> > be the one to focus on and that the 60 minute call to needle is a better
> > target and nearer the time that really matters of pain to needle but is
> the
> > bit we have control of in the health system. How do people feel about
> > this????- Comments very welcome as big meeting on Friday
> >
> > Dr Katherine Henderson
> > A&E Homerton/RLH
> > ----- Original Message -----
> > From: <[log in to unmask]>
> > To: <[log in to unmask]>
> > Sent: Monday, October 14, 2002 10:39 AM
> > Subject: Re: Hurry up there get a move on!!!![Scanned]
> >
> >
> > > The inside word is that this may not go ahead and that door to needle
> > times will be kept at 30mins - there is concern that insufficient
> hospitals
> > will be able to achieve 20mins and the government will not look good
> > > FB
> > >
> > > ----------
> > > From: p=NHS NATIONAL
> > INT;a=NHS;c=GB;dda:RFC-822=ACAD-AE-MED(a)JISCMAIL.AC.UK;
> > > Sent: 14 October 2002 10:34
> > > To: p=NHS NATIONAL
> > INT;a=NHS;c=GB;dda:RFC-822=ACAD-AE-MED(a)JISCMAIL.AC.UK;
> > > Subject: Re: Hurry up there get a move on!!!![Scanned]
> > >
> > > I am really excited by this. What is the source of your info.?
> > >
> > > JP
> > >
> > > >>> Danny McGeehan 10/12/02 07:09pm >>>
> > > Door to needle times are to be reduced from 30 to 20 mins in the
> > next 12
> > > months in spite of the fact that there is no literature to
> support
> > the
> > > clinical effectiveness of this move. The rationale being that
> if
> > it is
> > > quicker it must be better. A&E Depts showing a 100% compliance
> > will be given
> > > Beacon status and the lead clinicians will be given 3 DP's.
> > >
> > > Units that do not acheive the golden 30 min rule will be
> > downgraded to trauma
> > > centres. However to improve the targets and to crank up the A&E
> > staff who are
> > > not working efficiently or dare I say it hard enough there are
> now
> > plans afoot
> > > to reduce door to needle times even more and figures of 10 mins
> or
> > dare I say
> > > it 5 minutes are being quoted to make the system one of the most
> > efficient in
> > > the world. Already clinical staff are being recruited to
> collate
> > data from
> > > overstaffed units to monitor the effectiveness of the new
> targets.
> > >
> > > Don't say you haven't been warned I heard this from a usually
> very
> > reliable
> > > source. Please keep it under your hat.
> > >
> > > Danny McGeehan
> > >
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