Katherine, some answers to your questions:
1) Yes (very much so!).
2) Yes, we have a chest pain working group consisting of representation
from the emergency department, general physicians, cardiologists,
clinical chemists, pharmacy, and management. I am the chairman of this
group. We are responsible for achieving NSF targets, developing
guidelines, etc.
3) We perform the vast majority of thrombolysis within the Trust in the
ED and we audit our DTN times stringently, assisted by the Trust audit
department, and present the results at our monthly clinical governance
meetings; they are also reviewed monthly at Trust Board level.
4) Our data is submitted to MINAP by the cardiologists (what happens in
the ED as part of emergency care reflects only the begining of the MINAP
database, which is largely completed on CCU).
I feel that the management of acute coronary syndromes is core emergency
medicine work (indeed, one of the most important clinical areas with
which we deal) and that we should lead in the management of these
patients, developing guidelines for risk stratification, rule-out
strategies, and interventions (determining individual patient
suitability for thrombolysis, GpIIB/IIIA's, PCI, etc.). After all, most
of these patients present to us, not to the in-patient teams. This
requires good communication with our colleagues in cardiology and firmly
established clinical credibility.
Jason Kendall,
Emergency Department,
Frenchay Hospital (North Bristol NHS Trust).
Katherine Henderson wrote:
> Thank you for your varied comments. Can I ask the A&E seniors
> specifically -1) Are you involved with a Trust promoted effort to
> achieve the thrombolysis/reperfusion targets? 2) Is there an NSF
> steering group in your hospital and who is the lead for achieving the
> AMI targets - A&E , a cardiologist or a Physician. 3) Who controls the
> door to needle time data, who enters it into whatever database you
> have , 4) Who organises that it is submitted to MINAP?? Katherine
> Henderson
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