Good aphorisms.
I don't know about you chaps, but in our ED we're busting a gut to fast-
track acute MIs to coronary care...only to see the 'door to needle' time
get blown out of the water as the cardiology on-call resident/registrar
spends 30 minutes or so assessing the patient for whatever trials are
currently running, making a token attempt at 'consent', dialling an
international freephone number for randomisation and, finally, delivering
whatever cocktail of thrombolytic is deemed suitable.
If we acknowledge that reducing pain-to-needle time is appropriate, with
emergency departments rapidly assessing and triaging MIs to CCU, how do we
square this with delays in giving treatment in CCU so that patients can be
enrolled in trials. And no matter with how much gusto we approach this,
how 'informed' is the punter presenting (usually terrified) with an MI in
regard to taking part in a trial?
And don't even get me started on access to primary PTCA/stent vs.
thrombolysis during 'day hours' as opposed to night; or PTCA/stent vs.
thrombolysis decisions revolving around whether patient has private or
public cover...probably not much of a problem in the UK...anyone had
experience from the States?
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