{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T17:26:26Z","timestamp":1789061186538,"version":"build-2803163510"},"reference-count":14,"publisher":"Oxford University Press (OUP)","issue":"1052","license":[{"start":{"date-parts":[[2023,1,30]],"date-time":"2023-01-30T00:00:00Z","timestamp":1675036800000},"content-version":"vor","delay-in-days":3601,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2013,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Achieving target door\u2013needle times for ST elevation myocardial infarction remains challenging. Data on emergency department (ED) doctor-led thrombolysis in developing countries and factors causing delay are limited.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To assess the effect on door\u2013needle times by transferring responsibility for thrombolysis to the ED doctors and to identify predictors of prolonged door\u2013needle times.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methodology<\/jats:title>\n                  <jats:p>Data on medical on-call team-led thrombolysis at a tertiary Asian hospital were prospectively collected from May 2007 to Aug 2008 (1st study period). In September 2008, ED doctors were empowered to perform thrombolysis. The practice change was accompanied by new guidelines, tick chart implementation, and training sessions. Data were then consecutively collected from September 2008 to May 2009 (2nd study period). Door-to-needle times for the 1st and 2nd study periods were compared. All cases were analysed for factors of delay by multiple logistic regression.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>297 patients were thrombolysed, 169 by the medical on-call team during the 1st study period and 128 by the ED doctors during the 2nd study period. Median door\u2013needle times were 54 and 48\u2005min, respectively (p=0.76). Significant delays were predicted by \u2018incorrect initial ECG interpretation\u2019 (adjusted OR (aOR) 14.3), \u2018inappropriate triage\u2019 (aOR 10.4) and \u2018multiple referrals\u2019 (aOR 5.9). No cases of inappropriate thrombolysis were recorded.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Transfer of responsibility for thrombolysis to the ED doctors did not improve door\u2013needle times despite measures introduced to facilitate this change. Key causative factors for this failure were identified.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/postgradmedj-2012-131174","type":"journal-article","created":{"date-parts":[[2013,3,23]],"date-time":"2013-03-23T02:34:12Z","timestamp":1364006052000},"page":"335-339","source":"Crossref","is-referenced-by-count":7,"title":["Failure to improve door-to-needle time by switching to emergency physician-initiated thrombolysis for ST elevation myocardial infarction"],"prefix":"10.1093","volume":"89","author":[{"given":"Alexander","family":"Loch","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine\/Cardiology, University Malaya Medical Centre , Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tint","family":"Lwin","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University Malaya Medical Centre , Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Idzwan Mohd","family":"Zakaria","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University Malaya Medical Centre , Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imran Zainal","family":"Abidin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Malaya Medical Centre , Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wan Azman","family":"Wan Ahmad","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Malaya Medical Centre , Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Hautmann","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine\/Trauma surgery, University Malaya Medical Centre , Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2013,3,22]]},"reference":[{"key":"2023041906230298100_bib1","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1097\/00063110-200602000-00012","article-title":"Treatment of acute myocardial infarction in Scottish emergency departments: survey of current practice","volume":"13","author":"McKiernan","year":"2006","journal-title":"Eur J Emerg Med"},{"key":"2023041906230298100_bib2","first-page":"29","article-title":"An evaluation of door to needle time (DNT) of thrombolytic therapy following acute myocardial infarction in three large tertiary referral hospitals in Dhaka City","volume":"32","author":"Muqueet","year":"2006","journal-title":"Bangladesh Med Res Counc Bull"},{"key":"2023041906230298100_bib3","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.jemermed.2005.12.019","article-title":"Predictors of in-hospital delay to reperfusion in patients with acute myocardial infarction in Japan","volume":"31","author":"Fukuoka","year":"2006","journal-title":"J Emerg Med"},{"key":"2023041906230298100_bib4","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1016\/j.ahj.2010.03.022","article-title":"Delays in fibrinolysis as primary reperfusion therapy for acute ST-segment elevation myocardial infarction","volume":"159","author":"Glickman","year":"2010","journal-title":"Am Heart J"},{"key":"2023041906230298100_bib5","doi-asserted-by":"crossref","first-page":"b1807","DOI":"10.1136\/bmj.b1807","article-title":"Association of door-to-balloon time and mortality in patients admitted to hospital with ST elevation myocardial infarction: national cohort study","volume":"338","author":"Rathore","year":"2009","journal-title":"BMJ"},{"key":"2023041906230298100_bib6","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1016\/S0140-6736(96)02514-7","article-title":"Early thrombolytic treatment in acute myocardial infarction: reappraisal of the golden hour","volume":"348","author":"Boersma","year":"1996","journal-title":"Lancet"},{"key":"2023041906230298100_bib7","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1016\/j.annemergmed.2008.11.011","article-title":"Emergency department triage of acute myocardial infarction patients and the effect on outcomes","volume":"53","author":"Atzema","year":"2009","journal-title":"Ann Emerg Med"},{"key":"2023041906230298100_bib8","doi-asserted-by":"crossref","first-page":"2173","DOI":"10.1016\/j.jacc.2007.09.011","article-title":"Universal definition of myocardial infarction","volume":"50","author":"Thygesen","year":"2007","journal-title":"J Am Coll Cardiol"},{"key":"2023041906230298100_bib9","first-page":"313","article-title":"Emergency physician versus cardiologist-initiated thrombolysis for acute myocardial infarction: a Singapore experience","volume":"45","author":"Irwani","year":"2004","journal-title":"Singapore Med J"},{"key":"2023041906230298100_bib10","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.aaen.2006.11.004","article-title":"Guideline implementation fails to improve thrombolytic administration","volume":"15","author":"Kinsman","year":"2007","journal-title":"Accid Emerg Nurs"},{"key":"2023041906230298100_bib11","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1136\/emj.2004.014449","article-title":"Emergency department thrombolysis improves door to needle times","volume":"21","author":"Corfield","year":"2004","journal-title":"Emerg Med J"},{"key":"2023041906230298100_bib12","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1177\/0218492309338130","article-title":"Door-to-needle times in acute myocardial infarction","volume":"18","author":"Yaylali","year":"2010","journal-title":"Asian Cardiovasc Thorac Ann"},{"key":"2023041906230298100_bib13","doi-asserted-by":"crossref","first-page":"508","DOI":"10.5152\/akd.2010.167","article-title":"Impact of a well-organized collaborative team approach on mortality in patients with ST-segment elevation myocardial infarction","volume":"10","author":"Yaylali","year":"2010","journal-title":"Anadolu Kardiyol Derg"},{"key":"2023041906230298100_bib14","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1136\/heart.84.3.262","article-title":"Improving door to needle times with nurse initiated thrombolysis","volume":"84","author":"Wilmshurst","year":"2000","journal-title":"Heart"}],"container-title":["Postgraduate Medical Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/pmj\/article-pdf\/89\/1052\/335\/50017345\/postgradmedj-89-335.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/pmj\/article-pdf\/89\/1052\/335\/50017345\/postgradmedj-89-335.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,19]],"date-time":"2023-04-19T06:26:44Z","timestamp":1681885604000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/pmj\/article\/89\/1052\/335\/6987495"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,3,22]]},"references-count":14,"journal-issue":{"issue":"1052","published-online":{"date-parts":[[2013,3,22]]},"published-print":{"date-parts":[[2013,6,1]]}},"URL":"https:\/\/doi.org\/10.1136\/postgradmedj-2012-131174","relation":{},"ISSN":["0032-5473","1469-0756"],"issn-type":[{"value":"0032-5473","type":"print"},{"value":"1469-0756","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2013,6]]},"published":{"date-parts":[[2013,3,22]]}}}