We moved to an A&E based thrombolysis service as opposed to an A&E when CCU
full service. This dramatically reduced thrombolysis times. However, it was
enhanced by the employ of a thrombolysis nurse who works closely between
cardiology and A&E and is very good at giving feedback to both sides. We are
still adapting the system and hopefully will see further improvements with
time but there is simply no way that times can be shorter if an unnecessary
transfer is included in the protocol (i.e. A+E to CCU).

The system is not perfect but it is still developing. If you like I can send
you the data that shows the change in the number of MI's thrombolysed within
30 mins. In particular I think it is important to lok at the barn door MI's
i.e. those that have a good history and a positive initial ECG - as those
are the ones we really should always get and thrombolyse within 30 mins.

Of interest. Thrombolysis is likely to become a marker for the performance
of healthcare. Is the appointment of a thrombolysis nurse a cynical move of
resources towards this or just good management??

Simon Carley
SpR in Emergency Medicine
Hope Hospital
Salford
England
[log in to unmask]
-----Original Message-----
From: Rowland Cottingham <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Cc: [log in to unmask] <[log in to unmask]>
Date: 13 July 1999 07:12
Subject: Turf wars again


>My cardiologist is claiming that 'most' A&E units are now finding that
>they are doing less thrombolysis because the cardiologists are providing a
>better service. I have a real issue with complete absence of co-operation
>and joint working locally, but I don't believe him. Most of the papers by
>A&E people say that A&E is the right place, those by cardiologists assert
>it is CCU. There is no national consensus at all as far as I can see. This
>is a plea for a position paper from BAEM (hell, I'll write it if you want)
>that looks at the available data and produces a bullet proof set of
>recommendations so that we can either brandish it at the cardiologists and
>assert our ground or stop doing thrombolysis and waft them all to CCU
>untreated and unstable as soon as possible - as that is what he seems to
>want. Do other cardiologists?
>
>Matthew (Cooke) mentioned an unpublished audit he did some months ago.
>This showed a tendency towards better outcomes with A&E thrombolysis. So
>how does that square with the cardiologist's claim that he can reduce
>mortality by 5% by cutting A&E out of the equation?
>
>Best wishes,
>
>
>Rowley Cottingham
>
>[log in to unmask]
>
>There are three kinds of men. The one that learns by
>reading. The few who learn by observation. The rest of them have to pee on
>the electric fence for themselves.
>
>




%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%