title: International benchmarking for acute thrombolytic therapy implementation in Australia and Japan.
abstract: Although a wide range of strategies have been established to improve intravenous tissue plasminogen activator (IV-tPA) treatment rates, international benchmarking has not been regularly used as a systems improvement tool. We compared acute stroke codes (ASC) between two hospitals in Australia and Japan to study the activation process and potentially improve the implementation of thrombolysis. Consecutive patients who were admitted to each hospital via ASC were prospectively collected. We compared IV-tPA rates, factors contributing to exclusion from IV-tPA, and pre- and in-hospital process of care. IV-tPA treatment rates were significantly higher in the Australian hospital than in the Japanese (41% versus 25% of acute ischaemic stroke patients, p=0.0016). In both hospitals, reasons for exclusion from IV-tPA treatment were intracerebral haemorrhage, mild symptoms, and stroke mimic. Patients with baseline National Institutes of Health Stroke Scale score⩽5 were more likely to be excluded from IV-tPA in the Japanese hospital. Of patients treated with IV-tPA, the door-to-needle time (median, 63 versus 54minutes, p=0.0355) and imaging-to-needle time (34 versus 27minutes, p=0.0220) were longer in the Australian hospital. Through international benchmarking using cohorts captured under ASC, significant differences were noted in rates of IV-tPA treatment and workflow speed. This variation highlights opportunity to improve and areas to focus targeted practice improvement strategies.
authors.affiliation: Department of Neurology, John Hunter Hospital, Hunter Medical Research Institute, and The University of Newcastle, Lookout Road, New Lambton Heights, NSW 2305, Australia.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kawano
authors.affiliation: Department of Neurology, John Hunter Hospital, Hunter Medical Research Institute, and The University of Newcastle, Lookout Road, New Lambton Heights, NSW 2305, Australia. Electronic address: christopher.levi@hnehealth.nsw.gov.au.
authors.forename: Christopher
authors.initials: C
authors.lastname: Levi
authors.affiliation: Department of Neurology, Stroke Center, Saiseikai Kumamoto Hospital, Kumamoto, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Inatomi
authors.affiliation: Department of Neurology, John Hunter Hospital, Hunter Medical Research Institute, and The University of Newcastle, Lookout Road, New Lambton Heights, NSW 2305, Australia.
authors.forename: Heather
authors.initials: H
authors.lastname: Pagram
authors.affiliation: Department of Neurology, John Hunter Hospital, Hunter Medical Research Institute, and The University of Newcastle, Lookout Road, New Lambton Heights, NSW 2305, Australia.
authors.forename: Erin
authors.initials: E
authors.lastname: Kerr
authors.affiliation: Department of Neurology, John Hunter Hospital, Hunter Medical Research Institute, and The University of Newcastle, Lookout Road, New Lambton Heights, NSW 2305, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Bivard
authors.affiliation: Department of Neurology, John Hunter Hospital, Hunter Medical Research Institute, and The University of Newcastle, Lookout Road, New Lambton Heights, NSW 2305, Australia.
authors.forename: Neil
authors.initials: N
authors.lastname: Spratt
authors.affiliation: Department of Neurology, John Hunter Hospital, Hunter Medical Research Institute, and The University of Newcastle, Lookout Road, New Lambton Heights, NSW 2305, Australia.
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Miteff
authors.affiliation: Department of Neurology, Stroke Center, Saiseikai Kumamoto Hospital, Kumamoto, Japan.
authors.forename: Toshiro
authors.initials: T
authors.lastname: Yonehara
authors.affiliation: Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Ando
authors.affiliation: Department of Neurology, John Hunter Hospital, Hunter Medical Research Institute, and The University of Newcastle, Lookout Road, New Lambton Heights, NSW 2305, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Parsons
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D019985:Benchmarking; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Acute stroke; Stroke code; System; Thrombolysis