Abstract W MP81: A Door-to-Needle Time Under 30 Minutes Can Be Achieved and Can Improve Functional Outcomes

Abstract

Background: Improvements in functional outcomes are greatest when intravenous tissue plasminogen activator (IV-tPA) is administered immediately following acute ischemic stroke (AIS). Our study objectives were to describe interventions administered by our Comprehensive Stroke Center to improve door-to-needle (DTN) time, report median DTN times, and determine if interventions influenced functional outcomes and sICH rates. Methods: A DTN task force was created to streamline care of suspected AIS patients; interventions included developing a launch pad for emergent evaluation near registration staffed by a neurologist, physician and stroke program coordinator, transferring patients directly to CT room before entering an ED room, and giving IV-tPA in the CT room. We examined patients that received IV-tPA between 1/1/10 - 6/25/14 and compared median DTN times and discharge mRS over the study period using the Kruskal-Wallis analysis of variance. The chi-square trend test was used to compare proportions of patients receiving IV-tPA in less than 60 minutes. Results: During the study period 245 patients received IV-tPA. There was a significant decrease in median DTN times over time, from 46 minutes in 2010 to 29 minutes in 2014 (p=.001, Graph), and there was a significant trend towards shorter DTN times over time (p<.001, Graph). Additionally, discharge mRS significantly improved over time (p=.03). There was 1 case of sICH in 2010 and 2012. Conclusions: Streamlining initial evaluation of suspected AIS patients can reduce DTN times, and was also associated with improvements in functional outcomes at discharge. There was no change in sICH rates.