Abstract WP401: Improving Door-to-Needle Time and Functional Outcomes in Patients Treated With Intravenous Thrombolysis

Abstract

Background and Objectives: The benefit of Intravenous (IV) tissue plasminogen activator (tPA) for acute ischemic stroke (AIS) is time-dependent. It is therefore essential to identify and treat eligible patients quickly. Our study aimed to investigate if the implementation of a new institutional stroke protocol reduces door-to-needle time (DNT) and improves outcomes in patients receiving tPA. Design and Methods: This is a retrospective study of patients treated with IV tPA at UC Irvine Medical Center between January 1, 2013 and December 31, 2017. A new acute stroke protocol was implemented in January of 2015 to allow the Stroke team to manage hypertension in the emergency room, to make decision for IV tPA before getting blood test results unless patient was taking anticoagulant, and to give IV tPA in the CT suite. The patients were divided into two groups: pre-intervention and post-intervention groups. Outcome measures include DNT for IV tPA, functional outcome per modified Rankin Scale (mRS) at discharge, rate of symptomatic intracerebral hemorrhage (sICH), and mortality. Statistical analysis was performed with unpaired t-test for continuous variables and χ2 test for categorical data. Results: Among the 294 consecutive patients receiving IV tPA, 90 were in the pre-intervention group between January 1, 2013 and December 31, 2014, and 204 were treated over a 36-month period in the post-intervention group between January 1, 2015 and December 31, 2017. Median DNT was significantly lower in the post-intervention group (42 ± 39.2 minutes vs 63 ± 32.2 minutes, P <0.001). The mRS at discharge was also significantly lower in the post-intervention group (2.91 ± 1.93 vs 3.41 ± 1.92, P<0.05). There was no significant difference in rate of sICH (2.0% vs 2.2%) and mortality (6.8% vs 6.5%) between the two groups. Conclusions: In this single center study, simple performance improvement initiative was shown to reduce DNT for IV tPA and to improve functional outcome at discharge significantly without increased risk of sICH or mortality. The interventions outlined in this study were safe and easily implementable at any hospitals in the U.S. and other countries.