Abstract
Introduction: Effectiveness of stroke thrombolysis is highly dependent on early initiation of therapy, and strategies have been developed to reduce the door-to-needle time (DTN). Aim: To determine the impact on DTN after introduction of stroke activation nurse (SAN) in a teaching hospital. Methods: Our hospital is the comprehensive stroke center serving western Singapore and admits about 900 acute ischemic stroke patients per year. Previously thrombolysis was commenced after evaluation in the Emergency Department (ED) and admission to the Neurology high-dependency unit, causing considerable delay to treatment. From May 2015, a SAN joined the stroke code and evaluated all thrombolytic candidates, obtained NIHSS scores, calculated the dose and prepared the tPA for administration in ED. From September 2016, addition of a second SAN allowed faster response, especially in simultaneous stroke activations. From a prospective database of our patients treated with thrombolysis, we compared patient characteristics and DTN during three 16-month periods before and after SAN participation: Jan 2014-Apr 2015 (Baseline), May 2015-Aug2016 (Period 1), and Sep 2016-Dec 2017 (Period 2). Results: A total of 555 patients received thrombolysis, with mean age 67.5 years, 41% female, 73% hypertension, 35% diabetes mellitus, 55% hyperlipidemia and 31% atrial fibrillation. More patients were thrombolysed after SAN participation in the stroke code, from 146 (14%) at baseline, to 191 (17.6%) in Period 1 and 218 (18.8%) in Period 2. The median (range) NIHSS scores during these periods were 16 (2-32), 13 (1-33) and 12 (2-35) respectively. Mean (SD) and median DTN at baseline was 80 ( ±32) and 77 mins, which decreased to 63 ( ±32) and 57 mins in Period 1, and 58 ( ±29) and 52 mins in Period 2 . Percentages of patients thrombolysed within 60 mins improved from 25.3% at Baseline to 56.5% and 67% during Periods 1 and 2 respectively. Conclusions: Our results showed that involvement of SAN was associated with decrease in DNT and enabled more patients to be treated with intravenous thrombolysis.
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