Abstract TP285: Improving Mobile Stroke Unit Intravenous Thrombolysis Times Through Parallel Processing

Abstract

Introduction: Mobile stroke units (MSU) provide pre-hospital delivery of intravenous thrombolysis (IVT) in the setting of acute ischemic stroke. We hypothesize continued experience with MSU leads to improved DTN times and we aim to identify contributing process factors related to earlier IVT decisions. Methods: We reviewed all patients who received IVT on the MSU from 2014-2017. Process metrics included door to doctor (telemedicine log-in time), door to CT performance time, and door to needle (DTN) times. Times are reported as medians with interquartile ranges (IQR). We analyzed the individual factors compared to DTN time with linear regression. Results: A total of 124 patients have received IVT since our MSU initiation in 2014. The population’s median age was 63.5 (range, 25-99) years old with initial NIHSS 9 (IQR 6-16). The total group’s DTN median times was 29 minutes (IQR 29-38, fastest time 11 minutes), with a linear relationship showing improvement in DTN times since MSU initiation (p=0.01). Door to CT performance times have improved over time (14 minutes, IQR 9-18, p<0.01). There was a strong linear relationship (figure) between lower DTN times and early door to doctor access times (8 minutes, IQR 6-12, p<0.01). Conclusion: Earlier door-to-doctor access in a MSU suggests a role of parallel processing in shorter IVT decisions.