Thrombolytic therapy guided by a decision analysis model: are there potential benefits for patient management?

Is nurse-led thrombolysis clinically safe, beneficial and acceptable?

This study examined the sensitivity and specificity of coronary care unit (CCU) nurses' ability to diagnose acute myocardial infarction (AMI) and to make an independent clinical decision about thrombolysis. The effectiveness of this simulated nurse-led thrombolysis was compared with the sensitivity and specificity of subsequent senior house officer diagnosis and actual treatment. A blinded, retrospective gold standard was provided by consultant cardiologists. Predictions were that: nurse-led thrombolysis would be no worse than current practice; it would lead to a significant time-saving in CCU door-to-needle times; CCU nurses would accept this potential development in their role. The first and second predictions were upheld. Regarding the third prediction, most nurses felt confident about diagnosing AMI and administering thrombolytics, but only half of those who completed an anonymous questionnaire said that nurse-led thrombolysis should be part of the nursing role. The comments against nurse-led thrombolysis related to extra responsibility, legal cover, professional and organisational support and backup, and financial reward. The results of this simulation study suggest that, providing these concerns are addressed, nurse-led thrombolysis may be clinically safe, beneficial and acceptable to nurses.