Abstract T P338: Time is of the Essence: A Nurse-Based Intervention to Improve Door to Needle Times

Abstract

Background: For acute ischemic stroke, the chance of improved recovery is directly impacted by the length of time from symptom onset to administration of intravenous tissue plasminogen activator (IV t-PA). Despite the importance of rapid treatment, stroke centers struggle with achieving consistent door to needle times of less than 60 minutes. In an effort to improve efficiency, we implemented a change in our response to the acute stroke patient by adding a dedicated stroke nurse and Nursing Flow Sheet that focuses on critical benchmarks (e.g., door to CT time) prior to treatment. We collected data on patients treated with IV t-PA pre- and post-intervention to determine if our process increased the number of patients receiving t-PA in less than 60 minutes. Methods: 137 patients (n=77 pre, 60 post) who were treated with IV t-PA between 2009-2013 were included in analysis. Student’s t-tests and Fisher’s exact tests were used to compare door to needle times pre- and post-intervention. Additional data were collected regarding: patient demographics, admission characteristics (e.g., day of the week), stroke severity, medical comorbidities, and other barriers to t-PA administration (e.g., need for antihypertensives or additional imaging). Results: With implementation, the mean time to treatment only decreased from 82 to 78 minutes (p=0.58); however, the percentage of patients successfully treated within 60 minutes of arrival improved from 26% to 58% (p=0.003). NIH Stroke Scale severity and need for additional imaging (i.e., CTA of the chest) were associated with increased time to treatment. Conclusion: The use of a dedicated stroke nurse and Nursing Flow Sheet as part of the acute stroke assessment reduces door to needle times and significantly increases the proportion of patients treated with IV tPA within 60 minutes from hospital arrival.