Abstract
Christchurch hospital is a tertiary hospital in New Zealand supported by five general neurologists with after-hours services provided mainly by onsite non-neurology medical residents. We assessed the transferrability and impact of the Helsinki Stroke model on stroke thrombolysis door-to-needle time (DNT) in Christchurch hospital. Key components of the Helsinki Stroke model were implemented first in 2015 with introduction of patient pre-notification and thrombolysis by the computed tomography (CT) suite, followed by implementation of direct transfer to CT on ambulance stretcher in May 2017. Data from the prospective thrombolysis registry which began in 2012 were analyzed for the impact of these interventions on median DNT. Between May and December 2017, 46 patients were treated with alteplase, 25 (54%) patients were treated in-hours (08:00-17:00 non-public holiday weekdays) and 21 (46%) patients were treated after-hours. The in-hours, after-hours, and overall median (interquartile range) DNTs were 34 (28-43), 47 (38-60), and 40 (30-51) minutes. The corresponding times in 2012-2014 prior to interventions were 87 (68-106), 86 (72-116), and 87 (71-112) minutes, representing median DNT reduction of 53, 39, and 47 minutes, respectively (p-values <0.01). The interventions also resulted in significant reductions in the overall median door-to-CT time (from 49 to 19 min), CT-to-needle time (32 to 20 min) and onset-to-needle time (168 to 120 min). The Helsinki stroke model is transferrable with real-world resources and reduced stroke DNT in Christchurch by over 50%.
Highlights
Intravenous thrombolysis with tissue plasminogen activator—alteplase—is the current standard treatment for ischemic stroke within 4.5 h of symptom onset (1)
The Helsinki stroke model consisted of 12 interventions aimed at reducing treatment delays prior to thrombolysis and the adaptation of this model resulted in 18-min reduction in thrombolysis delay to 25 min in Melbourne within 4 months (7)
The American Heart Association/American Stroke Association Target: Stroke initiative recommended a similar 10-step intervention (8) aimed at reducing door-to-needle times (DNT) and resulted in nearly 80% relative increase in the proportion of stroke tissue plasminogen activator (tPA) administered within 60 min of hospital arrival (9)
Summary
Intravenous thrombolysis with tissue plasminogen activator (tPA)—alteplase—is the current standard treatment for ischemic stroke within 4.5 h of symptom onset (1). The American Heart Association/American Stroke Association Target: Stroke initiative recommended a similar 10-step intervention (8) aimed at reducing door-to-needle times (DNT) and resulted in nearly 80% relative increase in the proportion of stroke tPA administered within 60 min of hospital arrival (9). The ethos of these models focuses on patient pre-notification, rapid clinical assessment, image acquisition, and treatment administration in a chain of responses requiring parallel processing by on-site radiology and neurology personnel. The aim of this paper is to report the transferrability and impact on DNT of the Helsinki stroke thrombolysis model to a New Zealand tertiary hospital. We assessed the transferrability and impact of the Helsinki Stroke model on stroke thrombolysis door-to-needle time (DNT) in Christchurch hospital
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