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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 > >