<p>The Department of Health (DoH), in the national service framework for coronary heart disease (DoH 2000) and later in Reforming Emergency Care (DoH 2001a), declared that by April 2003, 75 per cent of eligible patients diagnosed with acute myocardial infarction (AMI) should receive thrombolysis within 20 minutes of arrival in the emergency department. The term used to describe this is ‘door-to-needle time’ (DoH 2001a).</p>