ArticleEmergency medicine journal : EMJ2003
Nurse initiated thrombolysis in the accident and emergency department: safe, accurate, and faster than fast track.
Article in Emergency medicine journal : EMJ, 2003. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed, 1 citations in OpenAlex.
- Nurse Practitioner Contribution to Shortening the Time from Angiography Suite Entry to Puncture in Mechanical Thrombectomy for Acute Ischemic Stroke.Journal of neuroendovascular therapy · 2026Article
- [Training in clinical acute and emergency medicine - Supraspeciality in Germany : A concept for nationwide implementation!]Der Anaesthesist · 2018Review
- Stroke code simulation benefits advanced practice providers similar to neurology residents.Neurology. Clinical practice · 2018Article
- 24/7 Neurocritical Care Nurse Practitioner Coverage Reduced Door-to-Needle Time in Stroke Patients Treated with Tissue Plasminogen Activator.Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association · 2016Article
- A review of interventions and system changes to improve time to reperfusion for ST-segment elevation myocardial infarction.Journal of general internal medicine · 2008Review
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo reduce the time between arrival at hospital of a patient with acute myocardial infarction and administration of thrombolytic therapy (door to needle time) by the introduction of nurse initiated thrombolysis in the accident and emergency department.
methodsTwo acute chest pain nurse specialists (ACPNS) based in A&E for 62.5 hours of the week were responsible for initiating thrombolysis in the A&E department. The service reverts to a "fast track" system outside of these hours, with the on call medical team prescribing thrombolysis on the coronary care unit. Prospectively gathered data were analysed for a nine month period and a head to head comparison made between the mean and median door to needle times for both systems of thrombolysis delivery.
resultsData from 91 patients were analysed; 43 (47%) were thrombolysed in A&E by the ACPNS and 48 (53%) were thrombolysed in the coronary care unit by the on call medical team. The ACPNS achieved a median door to needle time of 23 minutes (IQR=17 to 32) compared with 56 minutes (IQR=34 to 79.5) for the fast track. The proportion of patients thrombolysed in 30 minutes by the ACPNS and fast track system was 72% (31 of 43) and 21% (10 of 48) respectively (difference=51%, 95% confidence intervals 34% to 69%, p<0.05).
conclusionDiagnosis of acute myocardial infarction and administration of thrombolysis by experienced cardiology nurses in A&E is a safe and effective strategy for reducing door to needle times, even when compared with a conventional fast track system.
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