Abstract 2399: Protocol for Rapid Acquisition and Interpretation of Head CT in Acute Stroke Patients Eligible for Thrombolysis
Introduction The American Heart Association’s quality improvement initiative, Target Stroke, is designed to reduce door-to-needle (DTN) times for IV r-tPA to improve patient outcomes. One of the quality indicators is time-to-CT scan and interpretation. Although, we were already meeting the recommended target, we sought to further enhance efficiency of this process in our institution.
Method We performed a retrospective chart review of patients with CT Brain Acute Stroke protocol orders from January to December 2010, which represents a one-year period after instituting changes to our CT protocol. Some of the changes included: improved emergency medical service communication, streamlined patient registration and emergency department (ED) training on time-sensitive stroke care elements. CT scan times were analyzed based on time ordered, time of completion, and radiology interpretation. Our review included DTN for IV r-tPA administration for acute stroke patients during the same time period.
Results Of the 571 acute stroke patients admitted through the ED during the study period, 12% received IV r-tPA. Of these, 79% received IV r-tPA within 60 minutes, with a mean (±SD) DTN time of 52 (±27) minutes. The relative efficiency of thrombolysis was attributed in part due to our fast-track CT head protocol process. The mean time from CT order to completion was 12 minutes and CT completion to verbal reporting to the ordering physician was 6 minutes.
Conclusion Using a multi-disciplinary approach for quality improvement in CT acquisition and interpretation times, we were able to enhance the efficiency of our overall DTN time. We believe that our protocol is easily adaptable in any Neurointensivist led stroke service, and would benefit patients on a national level to allow for more rapid administration of IV r-tPA by reducing delays in the CT head protocol. Developing a strong infrastructure that is hard-wired and part of the institutional culture resulted in decreased CT times along with 79% of stroke patients receiving r-tPA in less than 60 minutes. Are efforts have paid off; our hospital has been designated on the Target Stroke Honor Roll.
- © 2012 by American Heart Association, Inc.