title: Barriers to administering intravenous tissue plasminogen activator (tPA) for acute ischemic stroke in the emergency department: A cross-sectional survey of stroke centers.
abstract: OBJECTIVE
  The logistics involved in administration of IV tPA for acute ischemic stroke patients are complex, and may contribute to variability in door-to-needle times between different hospitals. We sought to identify practice patterns in stroke centers related to IV tPA use. We hypothesized that there would be significant variability in logistics related to ancillary staff (i.e. nursing, pharmacists) processes in the emergency room setting.
  
  
  METHODS
  A 21 question survey was distributed to attendees of the AHA/ASA Southwest Affiliate Stroke Coordinators Conference to evaluate potential barriers and delays with regards to thrombolysis for acute strokes patients in the Emergency Department setting. Answers were anonymous and aggregated to examine trends in responses.
  
  
  RESULTS
  Responses were obtained from 37 of 67 (55%) stroke centers, which were located mainly in the Southwest United States. Logistical processes differed between facilities. Nursing and pharmacy carried stroke pagers in only 19% of the centers, and pharmacy responded to stroke alerts only one-third of centers. Insertion of Foley catheters and nasogastric tubes prior to tPA was routine in some of the sites. Other barriers to IV tPA administration included physician reluctance and inadequate communication between health care providers.
  
  
  CONCLUSIONS
  Practices regarding logistics for giving IV tPA may be variable amongst different stroke centers. Given this potential variability, prospective evaluation to confirm these preliminary findings is warranted.
authors.affiliation: Washington University School of Medicine, Saint Louis, USA.
authors.forename: Mitch
authors.initials: M
authors.lastname: Hargis
authors.affiliation: Johns Hopkins University, Baltimore, USA.
authors.forename: Jharna N
authors.initials: JN
authors.lastname: Shah
authors.affiliation: Baylor College of Medicine, Houston, USA.
authors.forename: Janine
authors.initials: J
authors.lastname: Mazabob
authors.affiliation: Baylor College of Medicine, Houston, USA.
authors.forename: Chethan Venkatasubba
authors.initials: CV
authors.lastname: Rao
authors.affiliation: Baylor College of Medicine, Houston, USA.
authors.forename: Jose I
authors.initials: JI
authors.lastname: Suarez
authors.affiliation: Baylor College of Medicine, Houston, USA. Electronic address: bershad@bcm.edu.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Bershad
mesh_terms: D061605:Administration, Intravenous; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D004635:Emergency Medicine; D004636:Emergency Service, Hospital; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006782:Hospitals, Special; D006801:Humans; D009462:Neurology; D065816:Neuroscience Nursing; D010348:Patient Care Team; D010607:Pharmacy Service, Hospital; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology; D015912:Thrombolytic Therapy / Q000379:methods*; D061665:Time-to-Treatment; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Acute ischemic stroke; Barriers; Emergency department; IV tPA; Stroke centers