Improving door-to-needle times in acute ischemic stroke: The design and rationale for the American Heart Association/American Stroke Association's target: Stroke initiative

Gregg C. Fonarow, Eric E. Smith, Jeffrey L. Saver, Mathew J. Reeves, Adrian F. Hernandez, Eric D. Peterson, Ralph L. Sacco, Lee H. Schwamm

Research output: Contribution to journalArticle

206 Scopus citations

Abstract

Background and Purpose-The benefits of intravenous tissue-type plasminogen activator (tPA) in acute ischemic stroke are time-dependent, and guidelines recommend a door-to-needle time of ≤60 minutes. However, fewer than one third of acute ischemic stroke patients who receive tPA are treated within guideline-recommended door-to-needle times. This article describes the design and rationale of Target: Stroke, a national initiative organized by the American Heart Association/American Stroke Association in partnership with other organizations to assist hospitals in increasing the proportion of tPA-treated patients who achieve guideline-recommended door-to-needle times. Methods-The initial program goal is to achieve a door-to-needle time ≤60 minutes for at least 50% of acute ischemic stroke patients. Key best practice strategies previously associated with achieving faster door-to-needle times in acute ischemic stroke were identified. RESULTS-: The 10 key strategies chosen by Target: Stroke include emergency medical service prenotification, activating the stroke team with a single call, rapid acquisition and interpretation of brain imaging, use of specific protocols and tools, premixing tPA, a team-based approach, and rapid data feedback. The program includes many approaches intended to promote hospital participation, implement effective strategies, share best practices, foster collaboration, and achieve stated goals. A detailed program evaluation is also included. In the first year, Target: Stroke has enrolled over 1200 United States hospitals. Conclusions-Target: Stroke, a multidimensional initiative to improve the timeliness of tPA administration, aims to elevate clinical performance in the care of acute ischemic stroke, facilitate the more rapid integration of evidence into clinical practice, and improve outcomes.

Original languageEnglish (US)
Pages (from-to)2983-2989
Number of pages7
JournalStroke
Volume42
Issue number10
DOIs
StatePublished - Oct 1 2011

Keywords

  • acute stroke
  • quality improvement
  • quality of care
  • thrombolytics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing

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