Improving the time to thrombolytic therapy for myocardial infarction by using a quality assurance audit

Abstract

Study objective: To evaluate a program designed to improve the speed of delivery of thrombolytic therapy for myocardial infarction in an emergency department.

Design: Time to administer thrombolytic therapy was evaluated retrospectively in 1988. Then after physician and nurse education, time to therapy was audited in 1989 and 1990, with feedback to physicians.

Setting: A community hospital ED.

Participants: Eight board-certified emergency physicians were monitored in their treatment of 58 patients.

Interventions: After the 1988 audit, the results for each physician were made known. Physician and nurse education was undertaken, and it was agreed to continue the audit. Nurses were encouraged to order ECGs rapidly, physicians were encouraged to make the treatment decision before consulting private physicians, and a goal of therapy in less than one hour was established. Further feedback on times was given to the physicians in 1989.

Measurements and main results: Mean time from ED arrival to thrombolytic therapy was 63 minutes in 1988, 47 minutes in 1989, and 38 minutes in 1990. This fall in time was significant (P = .0002). The number of patients treated within one hour rose from 45% in 1988 to 67% in 1989 and to 96% in 1990.

Conclusion: Auditing time to thrombolytic therapy, combined with physician and nurse education and increased experience, can significantly improve the time to administration of thrombolytic therapy.