Abstract W MP101: Differences in tPA Door-to-Needle Time by Patient and Hospital Characteristics
Background: Achieving a door-to-needle time (DtN) of less than 60 minutes for providing IV tPA is a quality of care measure endorsed by the National Quality Forum. This study assesses whether differences exist in timely provision of IV tPA in the Paul Coverdell National Acute Stroke Registry (PCNASR).
Methods: There were 2952 patients from 178 hospitals with acute ischemic stroke (AIS) who received IV tPA in the PCNASR in 2012 available for analysis. Chi-square tests were used to test for comparison of DtN time by weekday vs. weekend (Sat or Sun), daytime (8 AM-6 PM) vs. non-daytime, NIHSS score (<10 vs. ≥10), race (white vs. other), and by calendar quarter. Hospitals were categorized by rates of achieving DtN ≤60 min (≥70%, 50-69%, 40-49%, 30-39%, 1-29%, and 0%) and number of patients treated to assess treatment by time of day, day of week, race, gender, and NIHSS.
Results: Of 2952 patients with AIS who received IV tPA, 44.8% received IV tPA ≤60 min in 2012 (39.2%, 42.8%, 45.8%, and 51.0% by calendar quarter, p<0.001 for trend). Overall, IV tPA was more likely to be given within 60 minutes during daytime hours, to men, and when NIHSS ≥10. Highest performing hospitals (rates ≥70% in ≤60 min) had no disparities by weekday, time of day, race, or gender. Hospitals achieving DtN in ≤60 min for most patients did so more often for patients with NIHSS score ≥10 compared to those with NIHSS <10. Hospitals treating at least 20 patients per year are more likely to achieve a DtN above 50% compared to those treating less than 20 per year (p<0.001).
Conclusion: Rates of achieving DtN ≤60 min continue to increase over time. There were no differences in day of week, or race overall, although significant differences in achieving DtN in ≤ 60 min exist by time of day, gender, and number of patients treated annually per hospital. These findings have implications for quality improvement interventions in all hospitals and also based on treatment population size.
Author Disclosures: M.G. George: Employment; Significant; Centers for Disease Control and Prevention. X. Tong: Employment; Significant; Centers for Disease Control and Prevention.
- © 2014 by American Heart Association, Inc.