Abstract
Background: Despite proven outcome improvements after acute ischemic stroke (AIS), adoption of intravenous tPA has been slow, particularly in non-academic medical centers. In 2010, San Diego County established a comprehensive stroke registry to benchmark stroke care across our region. We analyzed the change in tPA use frequency, treatment rate over time, and treatment variance between receiving facilities. Methods: The San Diego County EMS Stroke Registry includes all 16 stroke receiving centers in San Diego County, from which we analyzed mode of arrival (EMS, walk-in), door-to-needle (tPA) times (DTN), and treatment rate (ischemic stroke cases receiving tPA divided by total ischemic stroke cases) over time (January 2010- June 2017). Results: We captured a total of 23,913 discharges with AIS ( Table ). Of these, 58.5% arrived via EMS (41.5% walk-ins). The use of tPA increased from 7.5% in 2010 to 15.2% in 2017. The stroke incidence varied little; DTN reduced over time (2010: 128.8(±426.2) minutes; 2017: 58.4(±31.2) minutes); the variance of DTN between hospitals decreased (DTN SD: 2010: 426.2 minutes; 2017: 31.2 minutes). Conclusion: We show, across a large regional stroke registry, that tPA use increased and time to treatment decreased. This effect was similar across variant sized hospitals and seen in academic and non-teaching facilities. Through collaborative data-sharing, analysis and internal benchmarking, overall tPA treatment rates and times improved.
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