Bolus formulations of new thrombolytic agents for the treatment of acute myocardial infarction (AMI) may offer benefits in efficiency of administration, door-to-needle time, quality improvement, and costs. METHODS: A telephone survey of 23 experienced emergency room (ER) staff at community and urban hospitals encompassed "hassle" involved with thrombolytic administration. Nurses were asked to compare a hypothetical single bolus with an infusion formulation of rt-PA under assumptions of equal efficacy and safety. A "hassle" analysis examined the differences in aspects such as protocol complexity, interference with other tasks, potential for error, and training requirements. RESULTS: In all aspects, bolus injection was associated with significantly less hassle than infusion (p < .001). In particular, bolus injection was perceived as less problematic for nurses in terms of following the protocol, interference with timely performance of other tasks, distraction from other tasks, and hassle associated with the thrombolytic procedure. The results also suggested that bolus injections may reduce door-to-needle time. CONCLUSION: A single bolus thrombolytic may offer promise for improved ease of care, quality patient management, and incremental reductions in door-to-needle time. Direct observational studies are needed to more precisely measure the potential reductions in door-to-needle time using bolus injection.