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‘Time is tissue’ has become a mantra in emergency care: delays in treatment limit the opportunity to minimise damage caused by trauma and ischaemia, particularly for conditions like acute stroke or myocardial infarction where drugs and techniques can restore blood flow. The therapeutic time window may have widened for some forms of acute ischaemic stroke,1 2 but that does not mean that time is no longer critical. For ST-segment elevation myocardial infarction (STEMI), survival rates are higher if balloon angioplasty is performed earlier than 90 min from hospital presentation.3 4 Efforts to improve patient outcomes further by reducing time to treatment have taken a ‘whole pathway’ approach, from initial symptoms in the community to definitive intervention in the hospital. These have included raising public awareness,5 evaluating different routes of urgent referral to hospital6 and investigating the timing of admission to the hospital. There is now an extensive, but contradictory, literature on the impact of ‘off-hours’ admission on care processes in patients with a STEMI. A systematic review in 20147 reported a higher mortality and longer door-to-balloon times for weekend admissions, while a 2017 review8 found neither. A recent analysis of 4590 patients between 2005 and 2016 in the multicentre Melbourne registry9 has reported longer door-to-balloon times for weekend admissions (median 83 …
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