Helsinki model cut stroke thrombolysis delays to 25 minutes in Melbourne in only 4 months.
OBJECTIVE
To test the transferability of the Helsinki stroke thrombolysis model that achieved a median 20-minute door-to-needle time (DNT) to an Australian health care setting.


METHODS
The existing "code stroke" model at the Royal Melbourne Hospital was evaluated and restructured to include key components of the Helsinki model: 1) ambulance prenotification with patient details alerting the stroke team to meet the patient on arrival; 2) patients transferred directly from triage onto the CT table on the ambulance stretcher; and 3) tissue plasminogen activator (tPA) delivered in CT immediately after imaging. We analyzed our prospective, consecutive tPA registry for effects of these protocol changes on our DNT after implementation during business hours (8 am to 5 pm Monday-Friday) from May 2012.


RESULTS
There were 48 patients treated with tPA in the 8 months after the protocol change. Compared with 85 patients treated in 2011, the median (interquartile range) DNT was reduced from 61 (43-75) minutes to 46 (24-79) minutes (p = 0.040). All of the effect came from the change in the in-hours DNT, down from 43 (33-59) to 25 (19-48) minutes (p = 0.009), whereas the out-of-hours delays remain unchanged, from 67 (55-82) to 62 (44-95) minutes (p = 0.835).


CONCLUSIONS
We demonstrated rapid transferability of an optimized tPA protocol to a different health care setting. With the cooperation of ambulance, emergency, and stroke teams, we succeeded in the absence of a dedicated neurologic emergency department or electronic patient records, which are features of the Finnish system. The next challenge is providing the same service out-of-hours.
From the Departments of Neurology and Medicine (A.M., L.W., M.U., N.Y., B.Y., P.H., S.M.D., B.C.V.C), Nursing (L.W.), and Emergency Department (M.T.), The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; and Department of Neurology (A.M.), Helsinki University Central Hospital, Finland.
Atte
A
Meretoja
Louise
L
Weir
Melissa
M
Ugalde
Nawaf
N
Yassi
Bernard
B
Yan
Peter
P
Hand
Melinda
M
Truesdale
Stephen M
SM
Davis
Bruce C V
BC
Campbell
D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D004636:Emergency Service, Hospital; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome; D014218:Triage
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator