In-hospital care pathway delays: gender and myocardial infarction

Aim. This paper reports the in-hospital findings of a study identifying gender specific care pathway delays or treatment opportunities amongst Irish women and men hospitalized with myocardial infarction. Background. Reperfusion therapy is of optimum benefit when administered early, yet research shows that women continue to experience greater in-hospital delays to treatment than men. Method. A 1-year prospective census was carried out from December 2001 to November 2002 with 277 (31%) female and 613 (69%) male patients with myocardial infarction who were consecutively admitted to the six major teaching hospitals in Dublin, Ireland. Results. Women experienced greater 'Triage to first medical assessment' delays than men (P = 0.001), and waited a median of 30 minutes for their first medical contact, compared with 20 minutes for men (P < 0.0001). The median 'door to needle' time for women was 70 minutes in comparison with 52 minutes for men (P = 0.02). Women waited longer than men for aspirin (P = 0.02), whilst men received a bed in the coronary care unit almost 1 hour sooner than women (P < 0.0001). Despite these delays to treatment, women and men experienced similar rates of reperfusion treatment. Conclusions. In-hospital treatment delays experienced by women may limit their potential to achieve the maximum benefits from reperfusion therapies. Triage nursing provides the first entry point to hospital care for the majority of female patients with myocardial infarction, and therefore Accident and Emergency Department nurses are in an optimum position to influence positively the pathway of care for this group.