-----Original Message-----
From: The list will be of relevance to all trainees including
undergraduates and [mailto:[log in to unmask]]On Behalf Of Danny
McGeehan
Sent: 19 February 2001 20:31
To: [log in to unmask]
Subject: Re: NHS Direct (was Anaesthetic mishap)


Helen
I think the Govt. are trying to grind the nurses and doctors who actually do
the work into the dust.  Our latest is we must acheive door to needle times
of 20 minutes.  Does anyone out there in cyberspace have any evidence that
demonstrates the adavantages of 20 mins as opposed to 60 or 70 mins.
Danny McGeehan
Staffordshire


Danny,
Almost every trial of thrombolysis ever undertaken has clearly shown that
the earlier thrombolytic therapy is initiated the greater the survival
benefit. For example, look at the results of GISSI, ISIS-2, LATE, EMERAS and
FTT. In GISSI, the key trial of thrombolysis versus placebo, there was a 47%
reduction in mortality when SK was administered within one hour of symptoms,
falling to 23% mortality reduction at 2-3hours and 17% reduction at 3-6
hours.(1)

Quite clearly, the shorter the door-to-needle time the greater the patient
benefit: the fact that there is not a specific trial comparing a door to
needle time of 20 minutes with 60 minutes does not absolve us from the need
to improve performance in this area.

Furthermore, because MI is so common (300,000 people every year), even small
mortality gains will have a very large effect in terms of the number of
lives and quantity of functioning myocardium saved. I appreciate that the
current targets for call-to-needle and door-to-needle times are going to be
very difficult to meet, but it makes a nice change to be set targets that
will genuinely improve patient outcomes, as opposed to the usual process
measures such as waiting times.

Jonathan Benger.
SpR, Bristol.

1. Effectiveness of intravenous thrombolytic treatment in acute myocardial
infarction. Gruppo Italiano per lo Studio della Streptochinasi nell'Inforcto
Miocardio (GISSI). Lancet 1986;i:397-402.