Strategies used by hospitals to improve speed of tissue-type plasminogen activator treatment in acute ischemic stroke.

Abstract

BACKGROUND AND PURPOSE:

The benefits of intravenous tissue-type plasminogen activator in acute ischemic stroke are time dependent, and several strategies have been reported to be associated with more rapid door-to-needle (DTN) times. However, the extent to which hospitals are using these strategies and their association with DTN times have not been well studied.

METHODS:

We surveyed 304 Get With The Guidelines-Stroke hospitals joining

TARGET:

Stroke regarding their baseline use of strategies to reduce DTN times in the January 2008 to December 2009 time frame before the initiation of

TARGET:

Stroke and determined the association between hospital strategies and DTN times.

RESULTS:

Among 5460 patients receiving tissue-type plasminogen activator within 3 hours of symptom onset in surveyed hospitals, the median DTN time was 72 minutes (interquartile range, 55-94). Reported use of the different strategies varied considerably. Of 11 hospital strategies analyzed individually by multivariable analysis, 3 strategies were independently associated with shorter DTN times. These included rapid triage/stroke team notification (209/304 [69%] hospitals, 8.1-minute reduction in DTN time), single-call activation system (190/304 [63%] hospitals, 4.3 minutes), and tissue-type plasminogen activator stored in the emergency department (189/304 [62%] hospitals, 3.5 minutes). When analyzed incrementally, hospitals that used a greater number of strategies had shorter DTN times with 1.3 minutes (adjusted mean difference) saved for each strategy implemented (14 minutes if all strategies were used).

CONCLUSIONS:

Although the majority of participating hospitals reported using some strategy to reduce delays in tissue-type plasminogen activator administration for acute ischemic stroke, the strategies applied vary considerably and those most strongly associated with shorter DTN times were applied relatively less frequently.

• Authors: Ying Xian, Eric E Smith, Xin Zhao, Eric D Peterson, DaiWai M Olson, Adrian F Hernandez, Deepak L Bhatt, Jeffrey L Saver, Lee H Schwamm, Gregg C Fonarow
• Journal: Stroke (Stroke) Vol. 45 Issue 5 Pg. 1387-95 (May 2014) ISSN: 1524-4628 [Electronic] United States
• PMID: 24713527 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Fibrinolytic Agents
• Tissue Plasminogen Activator

Topics

• Brain Ischemia (drug therapy)
• Fibrinolytic Agents (administration & dosage)
• Hospitals (standards, statistics & numerical data)
• Humans
• Practice Guidelines as Topic
• Registries (statistics & numerical data)
• Stroke (drug therapy)
• Thrombolytic Therapy (standards)
• Time Factors
• Tissue Plasminogen Activator (administration & dosage)
• Treatment Outcome