Does initiation of an ambulance pre-alert call reduce the door to needle time in acute myocardial infarct?

OBJECTIVES To assess the effect an ambulance pre-alert call for patients with suspected acute myocardial infarction (AMI) would have on door to needle (DTN) times. METHODS We carried out back to back audits of DTN times following the initiation of the pre-alert calls. PARTICIPANTS All patients thrombolysed within the emergency department between July 2003 and April 2004 (inclusive). STATISTICAL ANALYSIS Mean DTN times and time to ECG pre-change and post-change were compared using the Two sample t test. The Fisher's exact test was used to compare pre-change and post-change proportions of patients seen within guideline times. RESULTS In total, 73 patients were thrombolysed with 40 of these arriving by ambulance. Eighteen of these 40 were pre-change and 22 were post-change. Four patients were excluded. Fifty per cent of the pre-change group had a DTN time of <30 minutes compared with 91% of the post-change group (p = 0.005, Fisher's exact test). The phase one mean DTN time was found to be significantly greater than that for phase two (Two sample t test, p = 0.016; 95% CI 1.6 to 14.6). CONCLUSIONS There was a significant reduction in DTN times after the introduction of the pre-alert call.