Target Stroke: Best Practice Strategies Cut Door to Thrombolysis Time to <30 Minutes in a Large Urban Academic Comprehensive Stroke Center

Nirav Bhatt, Erika T. Marulanda-Londoño, Kunakorn Atchaneeyasakul, Amer M. Malik, Negar Asdaghi, Nida Akram, Daniel D’Amour, Kathy Hesse, Tony Zhang, Ralph L. Sacco, Jose G. Romano

Research output: Contribution to journalArticle

Abstract

The therapeutic window for acute ischemic stroke with intravenous recombinant tissue plasminogen activator (IV rt-PA) is brief and crucial. The American Heart Association/American Stroke Association Target: Stroke Best Practice Strategies (TSBPS) aim to improve intravenous thrombolysis door-to-needle (DTN) time. We assessed the efficacy of implementation of selected TSBPS to reduce DTN time in a large tertiary care hospital. A multidisciplinary DTN committee assessed causes of delayed DTN time and implemented focused TSBPS in our urban academic medical center. We analyzed door-to-CT time, DTN time, and CT to IV rt-PA time in consecutive patients treated with IV rt-PA over 27 months preimplementation and 13 months postimplementation. One hundred forty-eight patients were included in the preimplementation and 126 in the postimplementation group. We found no significant difference between the groups in demographics, comorbidities, anticoagulation status, prethrombolysis hypertension treatment, arrival by EMS, after-hours arrival, or in stroke etiology. After implementation, median DTN time improved from 59 (interquartile range [IQR]: 52-80) to 29 (IQR: 20-41) minutes (P <.001). Door-to-CT time decreased from 17 (14-21) to 16 (12-19) minutes (P =.016), and CT-to-IV rt-PA time improved from 43 (IQR: 31-59) to 13 (IQR: 6-23) minutes (P <.001). Rates of symptomatic intracranial hemorrhage (2.7% vs 3.2%, P =.82) and treatment of stroke mimics (9% vs 13%, P =.31) were similar in both the groups. Individualized hospital gap analysis identifies targeted interventions that lead to rapid and sustained improvement in treatment times.

Original languageEnglish (US)
Pages (from-to)22-25
Number of pages4
JournalNeurohospitalist
Volume9
Issue number1
DOIs
StatePublished - Jan 1 2019

Keywords

  • acute ischemic stroke
  • door to needle
  • target stroke
  • thrombolysis

ASJC Scopus subject areas

  • Clinical Neurology

Fingerprint Dive into the research topics of 'Target Stroke: Best Practice Strategies Cut Door to Thrombolysis Time to <30 Minutes in a Large Urban Academic Comprehensive Stroke Center'. Together they form a unique fingerprint.

  • Cite this