Abstract T MP100: Improving Timeliness of TPA Administration: Re-vamping Emergency Department Processes to Decrease Door to Needle Times

Abstract

Introduction: Time to neuroimaging is one of the critical measures for fast thrombolysis in acute ischemic stroke (AIS). While many aim to give IV tPA under 60 minutes from hospital arrival (door-to-needle or DTN), every minute of delay decreases the chances of good outcomes. Following previous reports, we established a streamlined triage system (STS) for all out-of-hospital stroke alerts and report on the initial experience of this new system and its effect on DTN. Methods: We included all AIS with last known well (LKW) under 2 hours who were treated with IV tPA from 11/2012 to 06/2014 at our facilities. We excluded telestroke or patients who were transferred to us, implemented STS on November 01, 2013 and analyzed time to CT (start of the exam) and DTN for patients before (group 1) after (Group 2) that date, using the UCSD GetWithTheGuidelines® data set. STS includes rapid triage on the EMS stretcher in the ED to assess patient safety for immediate transfer by EMS to CT, without a detailed neurological assessment. Previously patients were roomed in the ED first and received a triage including a neurological exam. We assessed treatment times, ED arrival to CT (DTC) and DTN for each Group and assessed serious neurological and medical complications (episodes of increased intracranial pressure, cardiac or respiratory arrest) in radiology before and after STS. We used unpaired t-test for comparing means (continuous variables). Results: A total of 36 patients received IV tPA (Group 1: 22, Group 2: 14). Mean (±SD) times (minutes) for DTC was 15.9(7.3) versus 11.5(6.5) (NS), for DTN 62.6(17.7) versus 53.8(19.6) (NS). We saw no serious complication before or after STS. Conclusions: Our streamlined stroke triage is safe and we aim to continue our analysis to identify additional opportunities for shorten treatment times. Expanding STS to include all stroke patients may further shorten DTN.