title: Efforts to reduce the door-to-needle time of thrombolysis in acute ischemic stroke: video-assisted therapeutic risk communication.
abstract: OBJECTIVE
  Explaining the risks and benefits of recombinant tissue-plasminogen activator (rtPA) to eligible patients with acute ischemic stroke (AIS) within a few minutes is important but difficult. We examined whether a new thrombolysis program can decrease the door-to-needle (DTN) time when treating patients with AIS.
  
  
  METHODS
  A new rtPA thrombolysis program with video assistance was adapted for patients with AIS and their families. We retrospectively compared outcome quality before (2009-2011) and after (2012) the program began. Outcomes included DTN time, the percentage of rtPA thrombolysis within 3 hours of onset in all hospitalized patients with AIS who presented within 2 hours of onset (2 hr%) and the percentage of rtPA thrombolysis in all hospitalized patients with AIS (AIS%).
  
  
  RESULTS
  We recruited patients with AIS who had undergone thrombolytic therapy before (n = 18) and after (n = 14) the initiation of the new program. DTN time decreased (93 ± 24 minutes to 57 ± 14 minutes, p < 0.001) and the AIS% increased (2% to 5%, p = 0.010) after the program. The 2 hr% marginally significantly increased (18% to 33%, p = 0.080).
  
  
  CONCLUSIONS
  A thrombolysis program with video-assisted therapeutic risk communication decreased DTN time and increased the treatment rate of patients with AIS.
authors.affiliation: Stroke Center and Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan; Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: Cheng-Yang
authors.initials: CY
authors.lastname: Hsieh
authors.affiliation: Stroke Center and Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan.
authors.forename: Wei-Fen
authors.initials: WF
authors.lastname: Chen
authors.affiliation: Stroke Center and Department of Neurology, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: Chih-Hung
authors.initials: CH
authors.lastname: Chen
authors.affiliation: Department of Emergency Medicine, Tainan Sin Lau Hospital, Tainan, Taiwan.
authors.forename: Chih-Yuan
authors.initials: CY
authors.lastname: Wang
authors.affiliation: Department of Emergency Medicine, Tainan Sin Lau Hospital, Tainan, Taiwan.
authors.forename: Chien-Jung
authors.initials: CJ
authors.lastname: Chen
authors.affiliation: Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: Edward Chia-Cheng
authors.initials: EC
authors.lastname: Lai
authors.affiliation: Stroke Center and Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan. Electronic address: tschern@gmail.com.
authors.forename: Tsang-Shan
authors.initials: TS
authors.lastname: Chen
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000188:drug therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007258:Informed Consent; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods; D058996:Quality Improvement; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy*; D013624:Taiwan; D061665:Time-to-Treatment / Q000592:standards; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014741:Video Recording
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: cerebral infarction; emergency medicine; plasminogen activators; thrombolytic therapy