EFFECT OF FAST TRACK ADMISSION FOR ACUTE MYOCARDIAL-INFARCTION ON DELAY TO THROMBOLYSIS

Objective - To evaluate the impact of a fast track triage system for patients with acute myocardial infarction. Design - Comparison of delays in admission to hospital and in receiving thrombolytic treatment before and after introducing fast track system with delays recorded in 1987-8. Patients fulfilling clinical and electrocardiographic criteria for myocardial infarction were selected for rapid access to the cardiac care team, bypassing evaluation by the medical registrar. Setting - Major accident and emergency, cardiac and trauma centre. Subjects - 359 patients admitted to the cardiac care unit during 1 February to 31 July 1990 with suspected acute infarction. Main outcome measures - Accuracy of diagnosis and delay from arrival at hospital to thrombolytic treatment. Results - 248 of the 359 patients had myocardial infarction confirmed, of whom 127 received thrombolytic treatment. The fast track system correctly identified 79 out of 127 (62%) patients who subsequently required thrombolytic treatment. 95% (79/83) of patients treated with thrombolysis after fast track admission had the diagnosis confirmed by electrocardiography and enzyme analysis. The median delay from hospital admission to thrombolytic treatment fell from 93 minutes in 1987-8 to 49 minutes in fast track patients (p < 0.001). Delay in admission to the cardiac care unit was reduced by 47% for fast track patients (median 60 minutes in 1987-8 v 32 minutes in 1990, p < 0.001) and by 25% for all patients (60 minutes v 45 minutes, p < 0.001). Conclusion - This fast track system requires no additional staff or equipment, and it halves in-hospital delay to thrombolytic treatment without affecting the accuracy of diagnosis among patients requiring thrombolysis.