Target Stroke: Best Practice Strategies Cut Door to Thrombolysis Time to30 Minutes in a Large Urban Academic Comprehensive Stroke Center
| Autor: | Kathy Hesse, Erika Marulanda-Londoño, Amer M. Malik, Nirav Bhatt, Nida Akram, Tony Zhang, Jose G. Romano, Kunakorn Atchaneeyasakul, Daniel D'Amour, Ralph L. Sacco, Negar Asdaghi |
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| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Demographics business.industry medicine.medical_treatment Significant difference Short Report Stroke mimics Thrombolysis Targeted interventions 030204 cardiovascular system & hematology medicine.disease 03 medical and health sciences 0302 clinical medicine Interquartile range Emergency medicine medicine Neurology (clinical) business Stroke Acute ischemic stroke 030217 neurology & neurosurgery |
| Zdroj: | The Neurohospitalist. 9(1) |
| ISSN: | 1941-8744 |
| Popis: | The therapeutic window for acute ischemic stroke with intravenous recombinant tissue plasminogen activator (IV rt-PA) is brief and crucial. The American Heart Association/American Stroke Association Target: Stroke Best Practice Strategies (TSBPS) aim to improve intravenous thrombolysis door-to-needle (DTN) time. We assessed the efficacy of implementation of selected TSBPS to reduce DTN time in a large tertiary care hospital. A multidisciplinary DTN committee assessed causes of delayed DTN time and implemented focused TSBPS in our urban academic medical center. We analyzed door-to-CT time, DTN time, and CT to IV rt-PA time in consecutive patients treated with IV rt-PA over 27 months preimplementation and 13 months postimplementation. One hundred forty-eight patients were included in the preimplementation and 126 in the postimplementation group. We found no significant difference between the groups in demographics, comorbidities, anticoagulation status, prethrombolysis hypertension treatment, arrival by EMS, after-hours arrival, or in stroke etiology. After implementation, median DTN time improved from 59 (interquartile range [IQR]: 52-80) to 29 (IQR: 20-41) minutes (P < .001). Door-to-CT time decreased from 17 (14-21) to 16 (12-19) minutes (P = .016), and CT-to-IV rt-PA time improved from 43 (IQR: 31-59) to 13 (IQR: 6-23) minutes (P < .001). Rates of symptomatic intracranial hemorrhage (2.7% vs 3.2%, P = .82) and treatment of stroke mimics (9% vs 13%, P = .31) were similar in both the groups. Individualized hospital gap analysis identifies targeted interventions that lead to rapid and sustained improvement in treatment times. |
| Databáze: | OpenAIRE |
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