Abstract 2416: Reducing Door to Needle Time for Intravenous Alteplase in Community Hospital Based Primary Stroke Centers
Intravenous alteplase (i.v. t-PA) for ischemic stroke is most effective when given early after stroke onset. The current national treatment initiative, Target:Stroke aims to administer i.v. t-PA within 60 minutes of patient’s arrival to the ED. This goal is challenging for community based primary stroke centers that do not have 24 hours in-house neurologists or radiologists and who are not able to mix alteplase in the ED. In 2010, we conducted a focused review of Stroke Alert Timelines in two community based Primary Stroke Centers in Santa Clara, California. This review led to the hypothesis that door-to-needle times for i.v. alteplase in ischemic stroke could be reduced by improving communication between key responders and by expediting the delivery of i.v. alteplase from pharmacy to the ED.
METHODS: In January 2011 we implemented a new Emergency Room protocol for management of patients with acute ischemic stroke (Fig) and compared its performance with recent historical data in two community hospital based PSCs. This protocol emphasizes prompt communication between ED physician, on-call neurologist and radiology and expedites the delivery of i.v. alteplase to the ED.
FINDINGS: The average door to needle time for patients treated between January 2009 and December 2010 was 89.5 ± 35.7 min (median 77 min). During this period, two patients (3.1%) received the drug within 60 minutes of arrival to the ED. The average door to needle time for patients treated between January 2011 and July 2011, was 70.7 ± 28.9 min, (median 60 min, p < 0.02). During this period, fourteen patients (58.3%) received i.v. t-PA within 60 minutes of arrival to the ED.
CONCLUSION: an improved management protocol that optimizes communication between ED physician, neurologist, radiologist and pharmacy and makes alteplase promptly available at bedside, can significantly improve the door to needle time for i.v. alteplase in community hospital based primary stroke centers.
- © 2012 by American Heart Association, Inc.