Factors Effecting Delayed Time of Intravenous Thrombolytic Treatment in Patients with Acute ST-Elevated Myocardial Infarction in Photharam Hospital, Ratchaburi Province

Abstract

Objective: To study the factors having effects on the delay of intravenous thrombolytic administration in patients with acute ST-elevated myocardial infarction at Photharam Hospital, Ratchaburi Province.

Method: This is a retrospective descriptive study. Data were collected from acute ST-elevated myocardial infarction (STEMI) patients treated at the emergency and accident department, Photharam Hospital during October 1, 2013 to September 30, 2018. Medical record forms for acute STEMI patients treated with intravenous thrombolytic agent, and the treatment data in HOSxP Program were used as study tools. The data were presented in percentage, average, and standard deviation; t-test independent and chi-square test were implemented for the analysis of the factors relating to the delay of the administration of intravenous thrombolytic agent.

Results: It was found that the duration of ECG examination, physician’s diagnosis, and specialist’s consultation had statistically significant effects on delaying the intravenous thrombolytic drug administration in acute STEMI patients (p<.001) based on 56-patient-data. In addition, the time length of physician’s prescriptions, and patients or his/her relatives’ consenting for intravenous thrombolytic agent treatment significantly caused the acute STEMI patients receiving intravenous thrombolytic agent with delay (p<.01). The other factors, i.e., gender, education, risk factors, signs and symptoms, illness severity, patient referral system, patient arrival time, and screening, on the other hand, did not delay the intravenous thrombolytic agent treatment in acute STEMI patients.

Conclusion: The findings present that the medical care team and the treatment process from the patients on arrival at hospital to the patients on the start of intravenous thrombolytic  therapy are the crucial factors delaying the treatment of the intravenous clot-busting drugs in the acute STEMI patients; therefore, the development of acute STEMI patient fast track should be implemented in order to decrease work processes, and reduce time-consuming steps. The improvement of the screening process system must be furthermore applied with the purpose of the ECG examination is performed within 10 minutes after the patients arrival. The time guarantee must be set for all steps prior to the thrombolytic medicine taken in favor of the patients receive the drug within 30 minutes from their coming.