11th Annual Spring Meeting on Cardiovascular Nursing/European Journal of Cardiovascular Nursing 10 Suppl. 1 (2011) S1–S46 S3 Results: The direct entry pathway was implemented in May 2010, and the CTBT for patients admitted direct to our hospital have reduced. Patient safety has not been compromised. See table. Patients who were admitted directly have been asked about their experience. They have said: the process is quick, they are fully informed, the ambulance crews deal with them competently, and the lab staff are waiting for their arrival. Conclusions: The CCU nurses have embraced this development and expansion of their nursing practice, allowing major changes to be made to the Primary Angioplasty pathway within the existing infrastructure. Along with the work of all members of the multi disciplinary team this has significantly reduced times to treatment for patients. Results % CTBT < 150 mins Median CTBT Financial year 2009–2010 59/78 76%* 125 mins Quarter 1 (April-June 2010) 32/36 89% 111 mins Quarter 2 (July-Sept 2010) 44/45 98%* 99 mins *p = 0.0013 Acute coronary syndromes and ischaemic heart disease P34 Poster Knowledge of ACS symptoms: an Irish population survey F. O’Brien 1 , M. Mooney 1 , S. O’Donnell 1 , G. McKee 1 , D. Moser 2 1 Trinity College Dublin, Dublin, Ireland; 2 University of Kentucky, Kentucky, United States of America Background: Knowledge of symptoms of acute coronary syndrome (ACS) is essential in order that individuals can correctly identify symptoms of significance and seek care promptly. Sudden, severe chest pain is the most commonly identified ACS symptom. However, atypical symptoms are generally less well recognised. An individual’s decision to seek treatment is largely dependent on symptom recognition. Mortality and morbidity can be reduced through prompt recognition and treatment of ACS symptoms. Purpose: This study measured knowledge of heart attack symptoms in patients who were recently diagnosed with an acute coronary syndrome. Methods: Data were collected from patients (N = 1,938) admitted with an ACS event. Recruitment took place in five of the Major Academic Teaching Hospitals in Dublin. Ethical approval was granted for this cross- sectional study. Knowledge of heart attack symptoms was measured on a dichotomous scale using the ACS Response Index questionnaire. From a list of 21 pre-defined symptoms, patients were asked to correctly identify those symptoms that could be representative of a heart attack. Data were analysed using SPSSv18. Results: Sample profile: Mean age: 63 years; Gender: male 72%; Diagnosis: STEMI (28%), NSTEMI (36.4%), Unstable Angina (35.6%). Consistent with the literature, knowledge of chest pain/pressure was correctly identified as a symptom by 98.9% and left arm/shoulder pain by 90.1%. Shortness of breath was identified by 86.1%. Almost half of those surveyed (50.5%, n = 978) did not recognise jaw pain, heartburn and/or indigestion (44.7%, n = 866), nausea/vomiting (47.7%, n = 925) and neck pain (42.5% n = 824) as heart attack symptoms. Yet, 81.6% (n = 1,581) agreed that palpitations/rapid heart rate were heart attack features. Conclusions: Symptoms of ACS such as chest pain, arm pain and shortness of breath appear to be well recognised. Despite their recent ACS event, patients’ knowledge of the less well known symptoms was deficient in this study. These findings underscore the necessity for the dissemination of precise information and education regarding ACS symptoms to high risk individuals. As symptom presentation cannot be pre-determined, the entire spectrum of potential heart attack symptoms should be included in cardiovascular education protocols. P35 Poster Irish pre-hospital delay times in acute coronary syndrome: an on-going dilemma M. Mooney 1 , F. O’Brien 1 , G. McKee 1 , S. O’Donnell 1 , G. Fealy 2 , D. Moser 3 1 Trinity College Dublin, Dublin, Ireland; 2 University College Dublin, Dublin, Ireland; 3 University of Kentucky, Kentucky, United States of America Purpose: This study measured baseline pre-hospital delay times among patients diagnosed with acute coronary syndrome in Ireland and compared them with baseline equivalents recorded five years previously by O’Donnell (2006). Pre-hospital delay time was interpreted as the time from acute symptom onset until arrival at the emergency department. Background: A significant number of deaths and substantial disability could be prevented if patients sought earlier treatment for symptoms of acute coronary syndrome. Researchers have reported European pre-hospital delay times between 2.0 hours and 3 hours 56 minutes. Irish median pre- hospital delay times of 3.1 and 1.8 hours for women and men respectively were reported by O’Donnell et al (2006). The revelation that there was an excessively long pre-hospital delay time by women in Ireland received much media coverage at that time. Methods: Data were collected for this cross-sectional study from patients who were admitted to an emergency department with an ACS event and diagnosed with a myocardial infarction (N = 936). They were recruited from 5 Major Teaching Hospitals in Dublin. Ethical approval was granted. The Response to Symptoms Questionnaire was used to ascertain the information. Data were analysed using SPSSv18. The delay time data was significantly skewed and was therefore log transformed for analysis. Results: Sample profile: Age: 62.59±11.91; Gender: 26%. Female; Diagnosis: 44% STEMI; 56% NSTEMI. The overall median delay time was 2.57 hours. A hierarchical multiple regression model was used to examine the effect of age, gender and diagnosis on delay time. The variance explained by the total model was significant: F(3,392) = −2.896, p = 0.046. By diagnosis, median delay times were 2.08 and 3.0 hours for STEMI and NSTEMI respectively. This was the only variable found to be statistically significant (beta=0.092, p = 0.005). By gender, median delay times were 2.5 hours (male) and 3.0 hours (female). Conclusion: Pre-hospital delay time in ACS has been highlighted for decades as a major international problem. Decreasing the time to treatment for patients with acute myocardial infarction is a life-saving goal. Yet, despite the extensive media coverage given to O’Donnell’s findings in 2006, pre-hospital delay times in Ireland have remained virtually unchanged among women and increased among men. This underscores the need for behaviour-altering approaches to the reduction of pre-hospital delay. This may take the form of targeted public education or educational interventions aimed at reducing pre-hospital delay. P47 Poster Barriers and successes to implementing an innovative consent form C. Decker 1 , B. Gialde 1 , J. McCartan 1 , J.A. Spertus 1 1 Mid America Heart Institute, Kansas City, United States of America Purpose: Implementing evidence-based information technology (IT) decision support within a hospital is complex and has not been widely studied. We created an evidence-driven, web-based tool, PREDICT (Patient Refined Expectations for Deciding Invasive Cardiac Treatments) which redesigns the procedure consent for patients undergoing percutaneous coronary intervention (PCI). In the context of deploying PREDICT to improve the quality of informed consent, we prospectively evaluated the challenges and successes of changing processes of care at several U.S. hospitals. Methods: We conducted qualitative, in-depth interviews with clinicians at 3 U.S. hospitals within 6 weeks of implementation of the new PREDICT individualized consent form. PCI volumes at each hospital ranged from 60 to 120 per month thus allowing for a sufficient number of consent forms to be generated and evaluated. Two experienced nurse researchers collected data and performed content analysis categorizing response as either supporting or impeding the implementation of PREDICT consent forms.