> If anyone at any point wants to raise an issue please let me
> know and I will do my best.
Well, a couple of issues from what you've said:
> The 60 minute target is the one that counts - with a 10%
> improvement in this year on year from a base line which will
> be published with the public MINAP report in June.
>
> Concern that everyone needs to realise that the 60 minute
> target is only achievable with some pretty radical
> prehospital thinking. All the improvements have come so far
> from the in hospital phase. Hence the pre-hospital
> thrombolysis enthusiasm- the only alternative is much shorter
> pre hospital times.
This seems a bit of aiming at a proxy measure. 60 minutes is a tight target.
We risk introducing prehospital thrombolysis to improve times by a couple of
minutes. Improving times is a good thing, however it is by no means clear
that the benefits of prehospital thrombolysis to hit a 60 minute target
against in hospital thrombolysis to hit a 90 minute target outweigh the
risks (let alone justifying the cost)- personally I'd be happier having my
thrombolysis in hospital. Bear in mind that the studies of prehospital
thrombolysis were all in settings with long in hospital delays.
Any work being done on improving pre hospital times? How do the times break
down in terms of response and scene time?
>
> A recognition that 20 minutes v 30 minutes does not make a
> huge difference but the 20 minute target still exists.
I like it. Seriously, though, the 20 minute target is somewhat dangerous- it
encourages juniors to initiate thrombolysis without checking for
contraindications or discussing with their seniors (I've just come across a
case of one of the inpatient docs trying to thrombolyse a patient with
aortic dissection without taking an adequate history). I'd also note that
there is about 5 minutes between arrival being logged from the ambulance and
the patient actually hitting the trolley so the target is nearer 15 minutes-
inadequate to take an ECG, explain to the patient and take consent in the
cases where the risk: benefit ratio isn't as good (older patients with
inferior MIs, time between 6 and 12 hours etc.)
Matt Dunn
Warwick
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