Abstract
Background: We describe a single center experience of 24hours 7days a week In-house attending Stroke neurologist presence starting April 2013, in reducing the delay in treatment of Acute Ischemic Stroke. Material and Methods: All consecutive ischemic stroke patients treated with IV alteplase (tissue plasminogen activator [tPA]) were retrospectively and prospectively registered in the stroke registry. In-hospital delays were analyzed as median/mean door-to-needle time (DNT) in minutes for patients receiving iv-tPA for the specified time periods. Results: A total of 262 patients were treated with tPA between April 2011 to July 2014. The mean DNT for the period 4/11 to 3/12 was 102 minutes, for 4/12 to3/13 was 67minutes and for 4/13 to current (7/14) was 38 minutes. (63% improvement compared to 2011/12) The DTN time during the ‘working hours’ (8 am to 5pm) as well as ‘out-of-hours’ were improved with significant percentage of patients being treated ‘out-of-hours’. The in hospital mortality, LoS (length of stay) and sICH (symptomatic ICH) were not adversely affected. Conclusion: We were able to demonstrate the feasibility of 24/7 in-house attending stroke Neurologist presence and its significant impact in reducing the delay in treatment time of acute ischemic stroke throughout the 24hour period.
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