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


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


OBJECTIVE
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.
From the Duke Clinical Research Institute, Durham, NC (Y.X., X.Z., E.D.P., A.F.H.); Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology & Neurotherapeutics, Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (D.M.O.); Department of Neurology, University of California, Los Angeles (J.L.S.); Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.L.B.); Stroke Service, Massachusetts General Hospital, Boston (L.H.S.); and Division of Cardiology, University of California, Los Angeles (G.C.F.).
Ying
Y
Xian
Eric E
EE
Smith
Xin
X
Zhao
Eric D
ED
Peterson
DaiWai M
DM
Olson
Adrian F
AF
Hernandez
Deepak L
DL
Bhatt
Jeffrey L
JL
Saver
Lee H
LH
Schwamm
Gregg C
GC
Fonarow
D002545:Brain Ischemia / Q000188:drug therapy*; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006761:Hospitals / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D017410:Practice Guidelines as Topic; D012042:Registries / Q000706:statistics & numerical data; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000592:standards*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
quality improvement; quality of health care; stroke