title: Perception Versus Actual Performance in Timely Tissue Plasminogen Activation Administration in the Management of Acute Ischemic Stroke.
abstract: BACKGROUND
  Timely thrombolytic therapy can improve stroke outcomes. Nevertheless, the ability of US hospitals to meet guidelines for intravenous tissue plasminogen activator (tPA) remains suboptimal. What is unclear is whether hospitals accurately perceive their rate of tPA "door-to-needle" (DTN) time within 60 minutes and how DTN rates compare across different hospitals.
  
  
  RESULTS
  DTN performance was defined by the percentage of treated patients who received tPA within 60 minutes of arrival. Telephone surveys were obtained from staff at 141 Get With The Guidelines hospitals, representing top, middle, and low DTN performance. Less than one-third (29.1%) of staff accurately identified their DTN performance. Among middle- and low-performing hospitals (n=92), 56 sites (60.9%) overestimated their performance; 42% of middle performers and 85% of low performers overestimated their performance. Sites that overestimated tended to have lower annual volumes of tPA administration (median 8.4 patients [25th to 75th percentile 5.9 to 11.8] versus 10.2 patients [25th to 75th percentile 8.2 to 17.3], P=0.047), smaller percentages of eligible patients receiving tPA (84.7% versus 89.8%, P=0.008), and smaller percentages of DTN ≤60 minutes among treated patients (10.6% versus 16.6%, P=0.002).
  
  
  CONCLUSIONS
  Hospitals often overestimate their ability to deliver timely tPA to treated patients. Our findings indicate the need to routinely provide comparative provider performance rates as a key step to improving the quality of acute stroke care.
authors.affiliation: Tufts Medical Center Floating Hospital for Children, Boston, MA (C.B.L.).
authors.forename: Cheryl B
authors.initials: CB
authors.lastname: Lin
authors.affiliation: Duke Clinical Research Institute, Durham, NC (M.C.).
authors.forename: Margueritte
authors.initials: M
authors.lastname: Cox
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, TX (D.W.M.O.).
authors.forename: DaiWai M
authors.initials: DM
authors.lastname: Olson
authors.affiliation: Duke University Medical Center, Durham, NC (G.W.B., M.C., E.D.P., B.R.S.).
authors.forename: Gavin W
authors.initials: GW
authors.lastname: Britz
authors.affiliation: Duke University Medical Center, Durham, NC (G.W.B., M.C., E.D.P., B.R.S.).
authors.forename: Mark
authors.initials: M
authors.lastname: Constable
authors.affiliation: Ronald Reagan-University of California at Los Angeles Medical Center, Los Angeles, CA (G.C.F.).
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: Massachusetts General Hospital, Boston, MA (L.S.).
authors.forename: Lee
authors.initials: L
authors.lastname: Schwamm
authors.affiliation: Duke University Medical Center, Durham, NC (G.W.B., M.C., E.D.P., B.R.S.).
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: Duke University Medical Center, Durham, NC (G.W.B., M.C., E.D.P., B.R.S.).
authors.forename: Bimal R
authors.initials: BR
authors.lastname: Shah
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D002545:Brain Ischemia / Q000175:diagnosis / Q000188:drug therapy*; D003695:Delivery of Health Care; D004334:Drug Administration Schedule; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D019983:Guideline Adherence; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010465:Perception; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012042:Registries; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000592:standards; D013997:Time Factors; D061665:Time-to-Treatment / Q000592:standards; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome; D014481:United States
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: hospital perception; quality improvement; quality of care; stroke; thrombolytics