Abstract 8: Delay In Consent Is a Common Reason For Delay In tPA Administration
Background: Hospitals target the “golden hour”, tPA within 60 minutes of stroke patient arrival to speed delivery of the drug. However this target is missed in > 50% of cases. Reasons for delays may be addressable.
Objective: Determine the type and frequency of delays in tPA treatment within New York State (NYS).
Methods: Reasons for delay in IV tPA beyond 60 minutes of hospital arrival were collected in the Get With The Guidelines (GWTG)-Stroke Patient Management Tool for hospitals participating in the NYS Department of Health (NYS DOH) Stroke Center Designation program. Data were a reporting requirement for all 2012 patient discharges. Abstractors selected all reasons either explicitly documented or clearly apparent - delay from door to stroke diagnosis, to MD, to stroke team, to CT, to CT read, to lab results, IV tPA order to initiated, difficult IV access, patient/family consent, equipment-related, management of concomitant emergent/acute condition, change in patient clinical status/condition, and other. Aggregate data for all NYS hospitals were obtained. Chi squared was used to test differences (2-tailed).
Results: From 41,709 records with 23,850 ischemic strokes enrolled in GWTG-Stroke from 120 hospitals in NYS during calendar year 2012, inpatient stroke cases were excluded (1,230) leaving 22,620 ischemic strokes. IV tPA was given to 1,991(8.8%). Delay in tPA occurred in 1,145 (58%) with reason for delay in 1,116 (97%). Patient/family consent was a factor in delay in 239 (21%). Other most frequently observed reasons being “other” in 369 (33%) and “management of concomitant emergent/acute condition” in 233 (21%). Females were more likely to experience delay due to patient/family consent compared with males (62% vs. 38%, p = 0.004). Weekend arrival was seen in 36% of consent delays (p = 0.001 from 27% expected).
Conclusions: Our state-level data suggest that issues with consent are one of the most common reasons for delay in tPA. A potential gender issue is raised requiring further study. Delay on weekend vs. weekday suggests Stroke Centers review variations in stroke center processes that may be present on weekends. Training and tools to improve and shorten the consent process may reduce delays.
Author Disclosures: S. Murphy: None. A. Colello: None. S.R. Levine: None.
- © 2015 by American Heart Association, Inc.