Abstract 24: Implementing Target Stroke Best Practice Time Sensite Guidelines Improves Door To Needle Time (DTN).
Implementing: Target Stroke Best Practice Time Sensitive Guidelines Improves Door to Needle Time (DTN)
Background: Target Stroke Honor Roll (TSHR) facilities have demonstrated compliance meeting Get With the Guidelines (GWTG) standards for care of the acute stroke patient. TSHR leaders collaborated and recognized there are similar barriers resulting in not achieving the DTN goal.
Objective: To review IV-TPA data of patients from TSHR facilities that did not meet the DTN time of less than 60 minutes and specify which of the three categories had the greatest delay. • Internal Process • Patient dynamics • Hemodynamic instability
Methods: A six month retrospective review of IV t-PA administrations from 9 Georgia TSHR facilities was performed. The review included those administrations that did not meet the DTN Goal of < 60 minutes. Meaningful intervals in treatment were calculated using uniformly abstracted data, and analyzed as proportions of the total DTN time (expressed as a decimal) with the cause(s) for the delay in t-PA administration in each case being placed in one of the three categories.
Results: There were 171 cases of which 48 (28%) did not meet the DTN goal time of 60 minutes or less. The data indicates that the most significant barrier to a DTN of < 60 minutes is the delay between resulted labs/ CT and the delivery of TPA. The intervals were the time from CT and labs resulted to TPA delivery (.52), patient arrival to MD arriving at the bedside (.13), the time from labs being drawn to labs being resulted (.32), the time from a CT being performed to the CT being resulted (.29), the time from when a CT was resulted to when TPA was ordered (.22), and the time from when TPA was ordered to when it was delivered (.27). Once the total data set was collated, a single factor ANOVA was performed. The results indicated a significant pattern in the data, and meaningful differences between variables (p-value = 1.43E-18). Category results: Internal Process; 28 (58%), Hemodynamic ; 9 (19%), Patient/family ; 11 (23%)
Conclusion: The data indicated the primary delay was related to Internal Process 58% (28/48). This concludes that continued vigilance on Target Stroke time sensitive Guidelines can impact the success rate of DTN < 60 minutes.
- © 2012 by American Heart Association, Inc.