A new study has found almost one third of heart attacks have been diagnosed late or missed in rural hospitals across New South Wales.
The University of Newcastle (UON) paper published this morning revealed a single change in hospital protocol dramatically improved the diagnosis, and from today is considered standard practice in the Hunter New England health district.
Twenty-nine small rural hospitals in the Hunter New England Local Health District were observed over 18 months in 20182020.
A patient who had taken themselves to hospital would only be assessed by emergency medical staff, and put into triage for diagnosis.
Twenty-seven out of 77 heart attacks in the period were not recognised within the first four hours, and considered 'missed'.
Small change, big difference
The study then started texting coronary specialists at Newcastle's John Hunter Hospital whenever a heart attack patient presented at a rural hospital without a cardiac ward.
The patient's electrocardiogram (ECG) would be instantly uploaded to Newcastle to be assessed by the specialist.
"They then call the rural hospital, discuss the case, then assist with diagnosis."
After the new protocol was introduced, zero out of 46 heart attacks were missed.
"We found that the diagnosis speed was increased, rates of missed heart attacks were reduced, and that ultimately means the treatment can be initiated more quickly," he said.
Dr Boyle believed the change would see rural patients receive service a city hospital would normally provide.
The hospitals and health centres observed included Armidale, Barraba, Bingara, Boggabri, Cessnock, Denman, Dungog, Glen Innes, Gloucester, Gunnedah, Guyra, Inverell, Kurri Kurri, Manilla, Merriwa, Moree, Muswellbrook, Narrabri, Quirindi, Scone, Singleton, Tenterfield, Tingha, Tomaree, Vegetable Creek, Walcha, Warialda, Wee Waa, and Murrurundi.
Not the gold standard yet
Alerting critical care coronary specialists at John Hunter has now become standard practice in the Hunter New England, with the supporting findings published this morning.
A full-time position has been created at John Hunter Hospital, servicing small rural hospitals specifically.
However, Dr Boyle said more research was needed to improve rural health outcomes.
"We need to get those response times down. We showed an improvement, but it's not at the gold standard," he said.
"Unless you put a cardiologist in every town, there will always be this issue of transferring people to major hospitals to get their invasive treatment."
