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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.