Abstract 202: Door-to-needle-time at 20 Minutes is Feasible and Safe
Background: Effect size of intravenous fibrinolysis in acute stroke depends on time to treatment, while safety depends on a systematic identification of risk factors for bleeding complications. Fibrinolysis is in Denmark the treatment with most potential of modifying outcome in acute stroke patients both in a quantitative and qualitative perspective. We initiated a quality project aiming at reducing our median door-to-needle-time (DTN). The aim of this study was to obtain median DTN below 20 minutes accepting no increase in bleeding complications.
Method: A team including neurologist, radiologist, stroke nurse and radiographer set up a structured patient admission process based on trauma team principles and experience with fibrinolysis. The team has immediate access to both CT and MRI; standard work up is CT + CTA. EMS informs of patients with likely symptoms of acute stroke and the patient is received by the team in a dedicated room. During a 3-month registration period from March to June 2013 an external person registered all cases of acute stroke evaluation. The registration covered time of symptom onset, time of arrival, needle time or decision of no thrombolysis and the distribution of the time used e.g. for blood sampling or CT. For comparison, data from our institution in 2012 was used.
Results: A total of 157 patients were evaluated and 148 patients were registered; nine patients (5,7%) missed time registration, however no significant difference in thrombolysis ratio was found between the missing and registered group (p=0,473). Patients had a median age of 67 years and 53,4% was male. Forty-seven patients (31,8%) received fibrinolysis. The overall median time is 16 minutes 58 seconds. For patients receiving fibrinolysis, the DNT was 20 minutes 58 seconds and for patients not receiving treatment the median time to desiscion was 15 minutes 50 seconds. No symptomatic intracranial hemorrhages or other significant bleeding complications occured during the study period. Median DTN in 2012 was 49 minutes. Costs were neutral.
Conclusion: DTN time can be reduced to 20 minutes by organizational interventions with no apparent effect on safety. NNT is reduced by 1 with every 20 minutes reduction in DTN so this intervention is likely to be highly clinically significant.
Author Disclosures: S.M. Henriksen: Research Grant; Significant; Sille M. Henriksen has received a 12 months scholarship from the Capitol Region of Denmark. L.L. Jeppesen: None. A. Christensen: None. H.K. Christensen: Research Grant; Significant; Hanne Christensen is Associate Research Professor, which is a grant from the Capitol Region of Denmark..
- © 2014 by American Heart Association, Inc.