Abstract W P275: Minimizing Door to Needle Times for Administration of rt-PA in Acute Ischemic Stroke
Background: A substantial opportunity exists to improve timeliness of IV rt-PA bolus administration within desired 60 minutes of Emergency Department triage presentation time in Ischemic Stroke patients. In 2010 only 21.4% (3/14) of eligible patients presenting to our 250 bed non-academic nonprofit community hospital received the IV rtPA bolus within time this time target.
Purpose: The purpose of this study was to demonstrate that implementation of best practices shown to minimize door-to-needle (DTN) time for administration of rt-PA in eligible Ischemic Stroke patients will result in significant improvement in percentage of patients receiving rtPA within 60 minutes of Emergency Department arrival.
Methods: A review of published data showing successful improvement methods to minimize DTN times was compiled to develop clinical practice guidelines which were implemented to increase staff commitment to implementation of best practices. Each thrombolytic stroke case was reviewed by members of Stroke Steering Committee throughout 2011, 2012 and 2013 to identify root causes contributing to delays, which allowed rapid performance data feedback to team members.
Results: The baseline DTN time for 2010 of 89.4 minutes, decreased to 68.8 minutes in 2011, and achieved a mean of 61 minutes in 2012 with 17/26 patients, or 65% of patients receiving IV rtPA within 60 minutes of arrival time. During Q1 and Q2 2013, 100% of the six eligible ischemic stroke patients presenting at this hospital received IV rtPA in less that 60 minutes.
Conclusions: Significant improvement in compliance for under 60 minutes DTN time for IV rtPA administration can be achieved with implementation of published best practices which encompasses collaboration with emergency medical system personnel to ensure rapid assessment for stroke signs and symptoms and pre-notification of our hospital to allow early activation of Laboratory and Imaging Department staff to ready for potential thrombolytic stroke patients, utilization of “thrombolytic stroke box” to facilitate prompt preparation of IV rtPA weight-based dose, and leveraging newly implemented electronic medical record to minimize documentation time.
Author Disclosures: C.J. Videtto: None. M. Finnegan: None. D. Thomson: None.
- © 2014 by American Heart Association, Inc.