The case of a stroke patient who missed out on clot-busting treatment because they took two hours to come by car to Dunedin Hospital is being used to remind general practitioners such patients should travel by ambulance.
Dunedin Hospital's internal medicine clinical leader, Dr Brendon Rae, said if patients were suitable for the special intravenous thrombolysis treatment, it had to be administered in the first four and a-half hours of the onset of a stroke.
Such patients would have to be assessed at the hospital and undergo a CT scan, which meant they had three and a-half hours to get to the emergency department, he said.
If the medicine was administered after four and a-half hours, the risks of it began to outweigh the benefits.
While it was impossible to say if the delay had affected the outcome for the patient who missed out on thrombolysis, he said it was a "frustrating" situation.
He reiterated his recent comments about the need for people to treat stroke symptoms with urgency and to seek medical help.
It was not unusual for people referred to the emergency department by GPs for a variety of conditions to put themselves last and take hours to get there, with people deciding they "had to get the cat sorted out" or organise "Uncle William's tea".
In the case of a suspected stroke, if an ambulance was ordered they had no choice but to arrive at the hospital promptly.
In her latest newsletter, board GP liaison officer Dr Anne Worsnop reminded GPs that patients being referred to Dunedin Hospital with suspected strokes should come by ambulance, rather than car, and be treated with the same degree of urgency as a heart attack.
Dr Worsnop said the local St John was happy with this policy.
The ambulance service gives advance warning to the emergency department that a suspected stroke patient is on their way.
Dr Rae said people from areas such as Balclutha and Dunstan were less likely to qualify for thrombolysis treatment because of the time involved, although there had been one case where "everything fell into place" and a patient had been flown by helicopter from Dunstan Hospital.
The newsletter also points out that patients referred to Dunedin Hospital's emergency department who have travelled by car may not be seen immediately by the specialty or sub-specialty to which they had been referred.
GPs have been asked to explain the triage process at the emergency department and also advise that it is not uncommon for diagnostic tests to be carried out before the patient is seen by the specialist or service.
This reminder follows several complaints from patients in recent months.
