Impact of a Region-Wide Approach to Improving Systems for Heart Attack Care: The West Midlands Thrombolysis Project

Objective: To describe changes in delay to administration of thrombolytic therapy associated with a region-wide audit. Design: Observational study of patients admitted with suspected myocardial infarction (MI) based on continuous audit. Subjects: 18877 patients admitted to 23 hospitals with suspected MI between April 1995 and March 1998. Results: Of 11232 patients with a discharge diagnosis of definite MI, 8802 (46.6%) received thrombolytic therapy during hospitalisation, with 5155 patients eligible for treatment on admission to hospital on the basis of established indications. Call-to-needle time for those eligible for treatment on admission fell from median 105 min in the first year of the project to 85 min in year 3 ( P<0.001), and door-to-needle time fell from 45 to 35 min ( P<0.001). Forty percent of eligible patients were treated within the then current national standard of 90 min from time of call for help, with nearly 49% in the final year and 20% being treated within the new national standard of 60 min, by the third year. Conclusion: The proportion of eligible patients receiving thrombolysis within 1 h of the call for help doubled during the 3-year project but the majority of patients still wait longer than 60-min ‘call-to-needle’. New systems to reduce delays to administration of thrombolysis to within 60 min of call for help are required, including consideration of pre-hospital treatment.

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No Evidence for Reduced Hospital Admissions or Increased Deaths from Stroke or Heart Attack During COVID-19

10.1101/2020.06.08.20119636 ◽

2020 ◽

Author(s):

Katharine Reeves ◽

Samuel Watson ◽

Tanya Pankhurst ◽

Kamlesh Khunti ◽

Suzy Gallier ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Attack ◽

Hospital Admissions ◽

Ambulance Service ◽

St Elevation Myocardial Infarction ◽

University Hospital ◽

The West ◽

West Midlands ◽

St Elevation ◽

The Uk

Articles in the UK press have claimed that hospital admissions for heart attack and stroke have declined during the COVID-19 pandemic. However, data from the West Midlands Ambulance Service have not shown any reduction in call-outs for patients with stroke or ST-Elevation Myocardial Infarction. This study examined data from University Hospital Birmingham NHS Foundation Trust, comparing admissions from week 1 of 2016 to week 17 of 2019, with the same period in 2020, pre- and post-lockdown. The results showed that there was no evidence of a reduction in the overall mean number of admissions of patients with these conditions in the post-lockdown period.

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Referrals to a New Regional Secure Unit — What Happens to Patients Refused Admission?

Medicine Science and the Law ◽

10.1177/002580248902900413 ◽

1989 ◽

Vol 29 (4) ◽

pp. 329-332 ◽

Cited By ~ 4

Author(s):

Michael Bond

Keyword(s):

First Year ◽

The West ◽

West Midlands ◽

Secure Unit

The new Regional Secure Unit for the West Midlands, the Reaside Clinic, had a total of 85 patients referred for admission during the first year of operation, of whom 32 were considered unsuitable for admission. The characteristics and outcome of these patients are discussed, together with the implications for forensic psychiatrists, general psychiatrists and prison medical officers.

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An audit on the management of pelvic inflammatory disease in the West Midlands, UK

International Journal of STD & AIDS ◽

10.1258/095646207782193885 ◽

2007 ◽

Vol 18 (10) ◽

pp. 717-719 ◽

Cited By ~ 3

Author(s):

M Walzman ◽

A Tariq ◽

S Bhaduri ◽

J D C Ross

Keyword(s):

Data Collection ◽

Pelvic Inflammatory Disease ◽

Inflammatory Disease ◽

National Standards ◽

National Standard ◽

Standards Of Care ◽

National Guidelines ◽

The West ◽

West Midlands

The potential complications of pelvic inflammatory disease (PID) make optimizing its management a high priority. A clinical audit of PID against current national management guidelines was conducted in 14 departments of genitourinary medicine in the West Midlands for women presenting with PID between January and December 2005. There were a total of 810 diagnoses of PID made from a total of 49,390 female attendees for that year, giving an incidence of 164 cases per 10,000 attendees. Of these 810 cases, data collection and analysis for this audit were performed on 139. An ofloxacin 400 mg twice daily (b.i.d.) based regimen was prescribed in 91 (65%, 95% confidence interval [CI] 57–73%) cases. Doxycycline 100 mg b. i. d. for 14 days plus metronidazole 400 mg b. i. d. for 5–14 days was prescribed in 44 (32%, 95% CI 25–40%) cases, but a third-generation cephalosporin was only given with this regimen in three cases. Partner notification was performed in 101 (73%, 95% CI 65–79%) cases. A total of 130 male contacts were recorded on the data collection forms, and of these 58 (45%) were traced and 51 (39%), treated. A follow-up appointment was given to 133 (96%, 95% CI 91–98%) women, although in most cases this was for seven days or more, and 104 (78%, 95% CI 67–81%) women attended for follow-up. Adherence to the national guidelines in this cohort of patients did not reach the national standard for choice of treatment regimen nor did it attain the target for proportion of male partners traced. Barriers preventing adherence to the national guidelines need to be explored and appropriate assistance given to physicians to help meet national standards of care.

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Recruiting psychiatrists – a Sisyphean task?

Psychiatric Bulletin ◽

10.1192/pb.bp.108.024638 ◽

2009 ◽

Vol 33 (10) ◽

pp. 390-392 ◽

Cited By ~ 11

Author(s):

Nick Brown ◽

Christopher A. Vassilas ◽

Clare Oakley

Keyword(s):

Medical Students ◽

Royal College ◽

Medical Specialty ◽

Medical Schools ◽

Psychiatric Training ◽

First Year ◽

The West ◽

Medical Graduates ◽

The Past ◽

West Midlands

SummaryIn 2009, the Royal College of Psychiatrists piloted a system for national recruitment to the first year of training (CT1) in England. This paper reviews the changes in recruitment of UK medical graduates to psychiatry over the past 20 years, both within the West Midlands and nationally. Fewer UK graduates are entering psychiatric training in the West Midlands despite the introduction of pre-registration training in psychiatry and the expansion of medical schools in the region; this picture is reflected nationally. Reasons for the continuing problems in recruitment are discussed and suggestions made for improving the attractiveness of psychiatry as a medical specialty. the latter include: engaging more closely with medical students, continuing to lobby politically with regard to overseas recruitment and presenting a unified vision of the profession.

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A pillot survey to investigate the nursing contribution to hospital-based patient assessment for thrombolytic therapy in the West Midlands

Clinical Effectiveness in Nursing ◽

10.1016/s1361-9004(99)80018-1 ◽

1999 ◽

Vol 3 (3) ◽

pp. 139

Author(s):

Julie Walker

Keyword(s):

Thrombolytic Therapy ◽

Patient Assessment ◽

The West ◽

West Midlands

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Dextropropoxyphene Deaths: Coroner's Report

Human Toxicology ◽

10.1177/096032718400300116 ◽

1984 ◽

Vol 3 (1_suppl) ◽

pp. 175s-185S ◽

Cited By ~ 17

Author(s):

R.M. Whittington

Keyword(s):

Respiratory Failure ◽

Drug Overdose ◽

The Elderly ◽

Hospital Treatment ◽

Accidental Death ◽

The West ◽

Common Cause ◽

West Midlands ◽

Drug Fatalities ◽

The Uk

1 Dextropropoxyphene has been increasingly prescribed as an analgesic in the UK, chiefly in the form of Distalgesic (dextropropoxyphene hydrochloride 32.5 mg and paracetamol 325 mg per tablet). After reports of sudden deaths from the misuse of this combination, prescribing is declining. 2 Distalgesic remains the most common cause of fatal drug overdose in the West Midlands, UK. The 1983 Birmingham inquests are compared with those from the year 1976 to 1979. 3 In comparison with other drug fatalities, death characteristically occurs rapidly, as little as 1 h after ingestion and usually before hospital treatment can be initiated. 4 Toxicity is increased by alcohol which is also extensively abused. 5 The fatal dose may be as small as 15 tablets or possibly less. 6 Many victims are young and some never intended to take their life. 7 Convulsions and respiratory failure precede death. The elderly and respiratory cripples may be more vulnerable to accidental death. 8 Evidence suggests a liability to dependence or even addiction with dextropropoxyphene.

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