Objective: To apply the Joint Royal College Ambulance Liaison Committee (JRCALC) checklist to patients who were deemed eligible for thrombolytic therapy on arrival in an Accident & Emergency Department (A&E) to determine the proportion suitable for prehospital thrombolysis. Design: Retrospective descriptive analysis. Methods: The clinical notes of all patients thrombolysed in an A&E department in a year were reviewed against the JRCALC guidelines for prehospital thrombolysis. Results: 14.2% of patients eligible for thrombolysis in a district general hospital were deemed suitable for prehospital thrombolysis according to the JRCALC criteria. The most common exclusion criteria were hyper/hypotension (50%), onset of symptoms (pain) .6 h previously (41.7%), or age .75 years (37%). Two or more contraindications to prehospital thrombolysis were present in 63.9% of patients. Conclusion: The JRCALC guidelines are an effective tool for identifying patients with potential contraindications to thrombolysis.

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months pre-implementation at each site were compared to 16 months post-implementation data. Results: Median total hospital LOS fell by 404 min (95% CI: 370-437 min) from 1210mins (IQR: 511-3494) to 806mins (IQR: 368-2300). ED LOS fell from 230mins (IQR: 163-352) to 213mins (IQR 150-307). There was an absolute decrease in hospital admissions of 13.1% (95% CI: 12.3-13.9%) from 70.4% to 57.3%. 5815 patients were managed on the ADP, accounting for 23.2% (95% CI; 22.7-23.8%) of possible cardiac chest pain presentations and closely matching ADAPT. Conclusion: The ADAPT ADP is applicable to routine clinical practice across a broad range of hospitals. Implementation had a profound positive impact on hospital LOS and admission rates for patients presenting with possible cardiac chest pain.