title: Simple text-messaging intervention is associated with improved door-to-needle times for acute ischemic stroke.
abstract: OBJECTIVE
  Timely administration of intravenous tissue-type plasminogen activator (IV tPA) is associated with improved outcomes for acute ischemic stroke; yet, developing processes to consistently provide prompt treatment remains a challenge. We developed and evaluated a simple quality improvement intervention designed to improve door-to-needle (DTN) times for resident-led Code Stroke teams at an academic medical center.
  
  
  METHODS
  We evaluated a simple text-messaging based intervention with real-time feedback to improve DTN times for intravenous tissue-type plasminogen activator. We used the rank-sum test and linear regression to evaluate for a change in DTN times that was temporally associated with the rollout of the intervention.
  
  
  RESULTS
  A total of 202 patients received intravenous tissue-type plasminogen activator; 94 preintervention and 108 postintervention. The median DTN time was significantly lower in the postintervention period (56 minutes [interquartile range 44-71] versus 82 minutes [IQR 68-103], P<0.0001) and a significantly higher proportion of patients were treated within 60 minutes (61% versus 16%, P<0.001).
  
  
  CONCLUSIONS
  A simple real-time text-messaging intervention was associated with a significant improvements in DTN times for acute ischemic stroke.
authors.affiliation: From the Departments of Neurology (M.M.B., L.Z., A.S.K.), Emergency Medicine (T.Q., W.W.), and Clinical Pharmacy (Z.C.), University of California, San Francisco.
authors.forename: Molly M
authors.initials: MM
authors.lastname: Burnett
authors.affiliation: From the Departments of Neurology (M.M.B., L.Z., A.S.K.), Emergency Medicine (T.Q., W.W.), and Clinical Pharmacy (Z.C.), University of California, San Francisco.
authors.forename: Lara
authors.initials: L
authors.lastname: Zimmermann
authors.affiliation: From the Departments of Neurology (M.M.B., L.Z., A.S.K.), Emergency Medicine (T.Q., W.W.), and Clinical Pharmacy (Z.C.), University of California, San Francisco.
authors.forename: Zlatan
authors.initials: Z
authors.lastname: Coralic
authors.affiliation: From the Departments of Neurology (M.M.B., L.Z., A.S.K.), Emergency Medicine (T.Q., W.W.), and Clinical Pharmacy (Z.C.), University of California, San Francisco.
authors.forename: Tina
authors.initials: T
authors.lastname: Quon
authors.affiliation: From the Departments of Neurology (M.M.B., L.Z., A.S.K.), Emergency Medicine (T.Q., W.W.), and Clinical Pharmacy (Z.C.), University of California, San Francisco.
authors.forename: William
authors.initials: W
authors.lastname: Whetstone
authors.affiliation: From the Departments of Neurology (M.M.B., L.Z., A.S.K.), Emergency Medicine (T.Q., W.W.), and Clinical Pharmacy (Z.C.), University of California, San Francisco. akim@ucsf.edu.
authors.forename: Anthony S
authors.initials: AS
authors.lastname: Kim
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement; D020521:Stroke / Q000188:drug therapy*; D060145:Text Messaging; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: door-to-treatment time; quality improvement; stroke; thrombolytic therapy