Will Your Stroke Be Treated in Detroit?
Background: rt-PA is the only currently available FDA approved therapy for acute ischemic stroke. We sought to determine the type and frequency of challenges/barriers to offering this therapy 4 years after FDA approval. Methods: We performed a systematic survey in April, 2000 of all 34 hospitals in the Detoit Metropolitan area (population 3.9 million people) that have an acute care emergency facility. A standardized, structured questionnaire/interview was conducted with the directors of the emergency facilities. Questions included: volume of stroke, priority of care given, relationship with Emergency Medical Services (EMS), use of protocols, pathways, and NIH Stroke Scale,time to processes and personnel involved. Surveys were returned, data was tabulated and analyzed descriptively. Results: All 34(100%) of the hospitals responded and wished to participate. While EMS called the Emergency Department(ED) prior to their transport of a suspected stroke patient in 28 centers (82%)only 19 centers (68%) utilized this information to expedite the care of the stroke patient. Stroke patients are given top priority for CT scanning in only 22 centers (64%). The range of times from ED arrival to CT scan performance ranged from 5 minutes to one hour. CT technicians are available 24hrs/day in-house in 56%. In the 44% with on-call, out-of-the hospital CT technicians, time to their arrival ranges from 30–60 minutes. Only a radiologist reads the CT in 18 Hospital, ED physicians review the CT in 15 and only a neurologist in 1. Only 10 (30%) collected data on stroke patients in the ED. Once the patient is considered for treatment with rt-PA, the number of physicians involved in the process varied from 1 to 3. Most commonly involved were a neurologist (22 centers) and ED physicians(at nearly all the centers). Stroke teams were involved at only two hospitals. If more than one physician is involved the average response time is 27 minutes. An NIHSS is performed in 53% of the hospitals. Conclusions: While considerable progress has been made in many Detroit-area hospitals to deliver rt-PA therapy for acute stroke, several key process improvement areas have been identified that could increase the percentage of acute stroke patients treated with rt-PA.