Resident-based acute stroke protocol is expeditious and safe.
OBJECTIVE
The decision to administer tPA to acute stroke patients is frequently made by stroke attendings or fellows, but placing residents in this position may make tPA delivery more efficient.


METHODS
Beginning in 2004, we instituted a resident-based acute stroke protocol placing neurology residents in decision-making roles. Time-intervals, symptomatic hemorrhage rate, and discharge locations were prospectively collected and compared between two epochs, before and after 2004.


RESULTS
59 acute ischemic stroke patients were treated with tPA before protocol initiation (1998 to 2002), while 113 patients were treated after protocol initiation (2004 to 2007). The average door-to-needle and onset-to-needle times were significantly shorter after initiation of the resident-based protocol (81 versus 60 minutes [P<0.001] and 138 versus 126 minutes [P<0.05]), respectively. Symptomatic hemorrhage rate (5.1% versus 3.5%) and favorable discharge location (68% versus 76%) did not differ between the two time periods.


CONCLUSIONS
A resident-driven tPA protocol, with formal training and quality control, is safe and efficient.
Ford
Andria L
AL
Department of Neurology, Cerebrovascular Disease Section, Washington University School of Medicine, St Louis, MO 63110, USA.
Connor
Lisa Tabor
LT
Tan
David K
DK
Williams
Jennifer A
JA
Lee
Jin-Moo
JM
Nassief
Abdullah M
AM
D000208:Acute Disease; D039602:After-Hours Care; D000368:Aged; D002545:Brain Ischemia / Q000188:drug therapy; D016208:Databases, Factual; D003657:Decision Making; D004632:Emergency Medical Services / Q000379:methods* / Q000592:standards; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007396:Internship and Residency / Q000379:methods* / Q000592:standards; D008297:Male; D009462:Neurology / Q000193:education* / Q000592:standards; D011786:Quality Control; D012449:Safety; D020521:Stroke / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator