Call-to-needle time measures "whole system" performance, which sounds great
at first. But by definition it lumps together prehospital times and hospital
response. It's very difficult then to work out who takes responsibility for
the area, and it will be easy for one end of the service to blame the other
for poor times; each end of the service won't be clear what their own target
is. I can just envisage the scenario: an ambulance crew taking their time up
to the 40 or 50-minute mark, still feeling they're well within target, but
leaving us poor hospital folk to get cracking with only 10 or 15 minutes to
go! I feel there's got to be separate targets for each area, and the DoH can
easily aggregate the times after the event. There would however have to be
greater clarification of what constitutes the handover time; here it's easy
to lose 5 or 10 minutes without being captured by audit, and this needs to
be tightened up.
Currently ambulance services don't seem to have any targets after they've
reached their patient, and I think that's a pity. They can spend an
inordinate amount of time doing things that really should wait until
hospital, especially in cardiac cases, and a prehospital target time would
tighten this up. However I foresee problems with those services that, for
example, do prehospital ECGs. They will be reluctant to do these if they
have a call-to-hospital target time of 30 minutes for example. Other factors
will also have to be taken into account; for example it might be reasonable
to aim for a 30-minute target time for an urban ambulance service, but it
wouldn't be for a rural service. Which brings me back to the idea of an
overall call-to-needle target of 60 minutes. This may be relatively easily
achievable in London, but it will be a lot more difficult in Norfolk or
Northumberland! Door-to-needle time, on the other hand, is easily measured
and would normally be expected to be consistent from trust to trust.
Adrian Fogarty
----- Original Message -----
From: "Katherine Henderson" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, October 14, 2002 10:20 PM
Subject: Re: Hurry up there get a move on!!!![Scanned]
> 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
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