Effectiveness of a 'thrombolysis nurse' in shortening delay to thrombolysis in acute myocardial infarction

To determine whether a specialist cardiac nurse would improve delay to thrombolysis in acute myocardial infarction (MI).Patients presenting with chest pain to a district general hospital.Comparison of: a) door-to-needle times of patients with 'definite' MI when the nurse was on and off duty (15 months) and prior to her employment (3 months); b) pain-to-needle times for definite MI; and c) door-to-needle times of patients without definite MI on first electrocardiogram (ECG) but who subsequently qualified for thrombolysis.Of 365 patients included in the study, 289 had definite MI. Before the appointment of a thrombolysis nurse, door-to-needle times were 0% at 30 minutes, 7% at 45 minutes and 34% at 60 minutes. Since the appointment, with the nurse on-duty, they have improved to 58%, 91% and 100% respectively, a saving of 36 minutes in median door-to-needle time (p = 0.0001). There was a median saving of 95 minutes in pain-to-needle times with the thrombolysis nurse on duty compared with off duty (p = 0.0001). Finally, with the nurse on duty there was also a saving of 36 minutes in median door-to-needle time in patients in whom the first ECG was non-diagnostic for MI (p = 0.02).A thrombolysis nurse produced a dramatic improvement in median door-to-needle and pain-to-needle times in patients presenting with definite MI. This would lead to an additional 41 lives saved at 30 months per 1,000 patients treated. With 24-hour thrombolysis nurse cover, this would potentially lead to 8 additional lives saved at 30 months at a cost of 12,300 Pounds each. There was also a striking improvement in door-to-needle times for patients presenting with a non-diagnostic first ECG who subsequently qualified for thrombolysis.