Abstract TMP66: Sustainably High Thrombolysis Rates Through SMART Criteria Training of Emergency Physicians: 10 Year Results

Abstract

Introduction: Thrombolysis rates remain low. One important factor is emergency physician (EP) participation. We routinely trained EPs to use SMART (Simplified Management of Acute Stroke Using Revised Treatment) criteria with real time feedback, resulting in high thrombolysis rates. The goal of this study was to determine the sustainability of this approach. Methods: Retrospective analysis of all consecutively treated IV rt-PA treated patients from 1/2006-6/2017, presenting to the ED at a large tertiary/quaternary stroke referral center. All EPs are trained using SMART criteria, which greatly lessen the contraindications to thrombolytic treatment. In addition the protocol requires response by the stroke neurologist ≤10min, and continuous real time feedback to the EP to maximize physician training. Formal in-service training is de-emphasized. Data regarding thrombolysis rates, and patient characteristics were routinely collected, including outcomes, safety and mortality. Results: From 1/06 to 6/17, 524 patients received thrombolysis . The IV rt-PA rate increased from 7% in 2004 prior the inception of the stroke program, to 24% in 2006. From 1/06 to 6/17, the annual rt-PA rate was sustained at an average of 30% (range 16-52%). The mean age was 72 (range 16-103), 54% were female. Mean pretreatment NIHSS score was 8.9 ± 7.9. 412 patients had discharge mRS recorded. Of these, favorable outcome (mRS ≤ 1) was observed in 43% (n=176). sICH rate was 1.1%, and mortality was 7.8%. Conclusions: A comprehensive acute ischemic stroke treatment protocol integrating EPs with real time education using SMART criteria is safe and highly effective, resulting in sustained high thrombolysis rates, excellent outcomes and low complication rates. This approach may also reduce unnecessary in-service training without reducing quality of care or thrombolysis rates.