Abstract 222: Changing Practice of Thrombolytic Therapy for Acute Ischemic Stroke in a Community Hospital After Implementation of Vascular Neurology Program

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Introduction: Despite significant increase in intravenous tissue plasminogen activator (IV tPA) treatment rates in the US, only 9.0% of patients with acute ischemic stroke (AIS) receive IV tPA in certified Primary Stroke Centers (PSC). The goal of this study is to analyze the effects of the implementation of a vascular neurology program in a PSC certified community hospital on IV tPA treatment rates and related stroke metrics. Methods: This quality improvement project (QIP) was undertaken at a community hospital, in Arlington, VA, which is 380 bed hospital, with The Joint Commission certification as a PSC. Intervention included implementation of evidence-based ischemic stroke IV tPA pathways with extensive hospital-wide medical and nursing staff training (25 lectures for nurses and 6 for MDs) by two newly appointed board certified vascular neurologists from Department of Neurology, George Washington University, Washington, DC. Study outcome measures were: IV tPA utilization rate (IV tPA/total AIS = %), proportion of patients with door to needle time (DTN) < 60 minutes (%), discharge home (%), and symptomatic intracerebral hemorrhage (SICH). We compared one year outcomes, pre- (August 1, 2017-18) and post-intervention (August 1, 2018-19). No IRB approval was required, as this was a QIP. Results: There were n=752 AIS admissions: n=337 pre- and n=415 post-intervention. There was a significant increase in stroke patient volume after intervention (1.4% vs. 1.8%, p=0.0006). There was significant increase from 28.0% (7/25) to 66.7% (24/36) in proportion of patients with DTN < 60 minutes pre- versus post-intervention (p=0.0032). Although IV tPA utilization rate [7.4 % (25/337) vs. 8.7% (36/415), p=0.52] and proportion of patients discharged home were higher after intervention (52% vs. 61%, p=0.48), they did not reach statistical significance. There was no difference in the rate of symptomatic hemorrhagic transformation between two cohorts (8.0% pre vs. 8.3% post, p=0.96). Conclusions: Implementation of an evidence-based vascular neurology program in a PSC community hospital resulted in a significant increase in proportion of patients with DTN less than 60 minutes, an increase in stroke patient volume, and a trend towards higher IV tPA utilization rate and better AIS outcome.