In our A&E we started thrombolysing people in the department in April this
year after a 2 year audit of figures of timings comparing people who had
phoned 999 and come by ambulance into A&E and then referred to thr medics and
CCU vs. patients who had phoned their GPs who had then either visited them
and then called an ambulance , or put in a request for an urgent ( not 999 )
ambulance which may take several hours. The reults were unequivocal - people
who called 999 themselves got into hospital far quicker - and as the
ambulances have no dirct access to CCu here - and also don't do 12 lead ECGs
- the place to throbolyse the quickest was A&E.
There was huge resistance from 1 of the 2 cardiologists - but eventually a
protocol was written and agreed and training was given to the A&E nurses.
Amid much anxiety, we started to thrombolyse - amd have done approaching 50
now. We are closely auditing all the times and complications as you can
imagine. When anything does happen adversly - even unavoidable reperfusion
arrythmias , we all wait in anticipation for a pile of abuse from CCU
regarding our 'incompetance ' !!
They feel we are stealing their thunder, don't know what we are doing , and
that their many years of administering thrombolysis is essential for the well
being of the patients. However, although we are not far into our series of
patients - the times are rewarding with most thrombolysis taking place within
25 minutes of door entry ( aim = 20 minutes )- and coupled with the reduction
in times because the patient came to us via a 999 call not a doctor referral,
we are hoping this will equate to a reduction in overall mortality.
As far as complications goes - the nurses are getting quicker mixing the
stuff up - as more of them get the chance to be involved, we transfer to CCu
as soon as the thrombolysis is started - CCU is only 90m seceonds away by
quick walk and no lifts ! We havn't had any disasters ( from our point of
view - not CCUs ! ) and we are set to continue ! But it was a long time in
coming !!
Judith
A&E Ipswich
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