Abstract T P277: “The July Effect” in Ischemic Stroke Patients Receiving tPA

Abstract

Objective: Each July thousands begin residencies and acquire increased responsibility for patient care. There is disagreement in the medical literature about whether a so-called July Effect, actually exists. There is paucity of data specifically looking at ischemic stroke patients receiving tPA. Approximately 1.9 million neurons die each minute from the onset of ischemia so we tried to evaluate if there is improvement in door to needle times for tPA administration from July to June. Methods: A Retrospective Review of patients admitted with symptoms of stroke to the Neurology department at our hospital from July 2013 to June 2014. Inclusion Criteria were all patients who met the criteria and received IV tPA. Results: During the study period, 60 patients met the criteria. The average tPA door to needle time in the month of July 2013 was 74.5 minutes and it increased to 93.5 minutes in the month of August 2013. The average door to needle time in the month of June 2014 was 45 minutes. There was significant decrease in the door to needle times form the month of July 2013 to June 2014 (p= 0.015). Please see figure 1 below for the average door to needle time over the year starting from July 2013 to June 2014. Discussion: The average door to need time is significantly lower in June 2014 when compared to July 2013 (P=0.015). It could be due to multiple factors including the new residents in the Emergency Department(ED) and Neurology residents taking call, as door to needle time includes the time when stroke alert was called after patient arrives in the ED, time taken by the neurology resident to examine the patient, time taken for the imaging, time taken for the decision to be made to give tPA, time taken by the pharmacy to get tPA ready and time to start tPA. Close supervision of the new residents with senior housestaff and adequate training including mock stroke activations may be helpful in overcoming this variation.