Abstract T P299: Effects of Quality Improvement Initiative on Time to Intra-Arterial Therapy in Acute Ischemic Stroke
Background: Acute stroke treatment is recognized to be time dependent. We sought to assess the effects of a quality improvement (QI) initiative called “Stroke60” on reducing time to intra-arterial therapy (IAT) for acute ischemic stroke patients transferred from an outside hospital to an academic center.
Methods: We reviewed acute ischemic stroke transfer patients who underwent attempted IAT for suspected large vessel occlusion. The time to IAT (tIAT) was defined as time from arrival at our institution to groin puncture. Stroke60 QI protocol entailed early notification of parallel service lines prior to patient arrival. We compared 2 cohorts of patients: pre-Stroke60 (January 1, 2010 to May 1, 2012) and post-Stroke 60 (May 1, 2012 to August 1, 2013). We collected data on demographics, National Institutes of Health Stroke Scale (NIHSS), frequency of neuroimaging (CT, CT angiogram/perfusion, or MRI brain) prior to IAT, and tIAT.
Results: Seventy-nine transfer patients underwent urgent cerebral angiogram for acute ischemic stroke (52 pre-Stroke60, 27 post-Stroke60). The mean age was 60.5 (range, 17 to 84 years) and the mean NIHSS was 19.5. Comparing post-Stroke60 with pre-Stroke60, there was no significant difference in age (p= 0.1), gender (p= 0.2), race (p= 0.8), or NIHSS (0.7). Stroke60 implementation resulted in a reduction of mean tIAT by 18 minutes (52.7 vs. 34.3 min, p= 0.04). Among the entire cohort, 25% (20/79) underwent neuroimaging prior to IAT. Neuroimaging prior to IAT was associated with increased delay of mean tIAT (74 min vs. 37 min, p= 0.0001). The post-Stroke60 cohort was more likely to have imaging prior to IAT compared to the pre-Stroke60 cohort (10% vs. 56%, p< 0.0001).
Conclusion: Despite being associated with an increased use of imaging from 10% to 56%, the “Stroke60” QI initiative was associated with a significant reduction in tIAT for acute ischemic stroke transfer patients. Further studies aimed at improving time to acute stroke therapies are warranted.
Author Disclosures: S.E. Holmes: None. J.J. Conners: None. S. Cutting: None. S.Y. Song: None. M. Chen: None. D. Lopes: Ownership Interest; Modest; Penumbra, Reverse Medical. Ownership Interest; Significant; Significant, Significant. Consultant/Advisory Board; Modest; Siemens, Stryker, Covidien. Consultant/Advisory Board; Significant; Significant, Significant, Significant. R. Moftaker: Consultant/Advisory Board; Modest; Covidien. Consultant/Advisory Board; Significant; Significant. K. Keigher: None. W. Stark-Riemer: None. E. Diebolt: None. V. Toll: None. V.H. Lee: None.
- © 2014 by American Heart Association, Inc.