Abstract
BackgroundThe benefit of intravenous thrombolysis (IVT) for acute ischemic stroke is time dependent. Despite great effort, the median door-to-needle time (DNT) was 60 min at the United States stroke centers. We investigated the effect of a simple quality improvement initiative on DNT for IVT.MethodsThis is a single-center study of patients treated with IVT between 2013 and 2017. A simple quality improvement initiative was implemented in January 2015 to allow the Stroke team to manage hypertension in the emergency room, to make decision for IVT before getting blood test results unless patients were taking oral anticoagulants, and to give IVT in the CT suite. Baseline characteristics, DNT and outcomes at hospital discharge were compared between pre- and post-intervention groups.ResultsNinety and 136 patients were treated with IVT in pre- and post-intervention groups, respectively. The rate of IVT was significantly higher in the post-intervention group (20% vs. 14.4%, p = 0.007). The median DNT with interquartile range (IQR) was reduced significantly by 23 min (63[53–81] vs. 40[29–53], p < 0.001) with more patients in the post-intervention group receiving IVT within 60 min (81.6% vs. 46.7%) and 45 min (64.0% vs.17.8%). There was no significant difference in symptomatic intracerebral hemorrhage rate (1.5% vs. 1.1%), modified Rankin Scale 0–1 (29.4% vs. 23.3%), and hospital mortality (7.4% vs. 6.7%) between the 2 groups.ConclusionsThree easily-implementable quality improvement initiative increases IVT rate and reduces DNT significantly without increasing the rate of IVT-related complications in our comprehensive stroke center.
Highlights
Intravenous thrombolysis (IVT) with tissue-type plasminogen activator is the proven medical therapy for acute ischemic stroke (AIS), with faster administration resulting in better outcomes [1, 2]
A total of 1305 patients with AIS were admitted to our medical center during the study period and 294 of them received and completed intravenous thrombolysis (IVT)
After excluding 68 patients treated during the transitional year of the quality improvement initiative, there were 90 patients in pre-intervention group and 136 in post-intervention group
Summary
Intravenous thrombolysis (IVT) with tissue-type plasminogen activator (tPA) is the proven medical therapy for acute ischemic stroke (AIS), with faster administration resulting in better outcomes [1, 2]. Researchers at Helsinki University Central Hospital in Finland were able to implement measures to reduce delays and cut the median door-to-needle time (DNT) to 20 min with interquartile range (IQR) 14–32 min [4]. A few hospitals in Canada and Netherlands were able to reduce median DNT to 25–37 min [6,7,8,9]. The benefit of intravenous thrombolysis (IVT) for acute ischemic stroke is time dependent. The median door-to-needle time (DNT) was 60 min at the United States stroke centers. We investigated the effect of a simple quality improvement initiative on DNT for IVT
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