Abstract T P346: ‘Expedite For Thrombolytic’ Patient Designation and Early Ordering for Improved Door-to-Needle Times in Acute Ischemic Stroke
Purpose: The American Heart Association’s ‘Target: Stroke Phase 2’ (TS2) ‘door-to-needle’ time sets a goal for IV tPA administration of <45 minutes in >50% of eligible patients. In order to meet this goal we delineated a set of patient characteristics which would trigger an expedited pathway for IV tPA administration. These characteristics included a well documented time of onset, obvious and significant stroke and no history of anticoagulant use. We then used this patient group to implement processes to decrease door to needle time. Methods: A retrospective cohort of 35 IV tPA, ED-administered cases from 5/2013-2/2014 were reviewed. DTN <60 minutes was achieved in 22 cases (62.9%, mean 62.0 min, median 45.0 min). EMS, field-initiated stroke codes expedited evaluation in 65.7% of patients. Turn-around-times (TAT) in Stroke Code processes (non-contrast head CT and laboratory results) demonstrated 95.7% compliance with benchmark times. The time of presentation to orders received for IV tPA revealed a mean of 48.8 min and median of 45.0 min. Cases with DTNs >60 minutes (n=13), documented reasons include family indecision (38.5%), blood pressure management (15.4%) and other (46.1%). Results: Neurologists, ER physicians, nursing, pharmacy, and radiology used the data to construct a new, consistent processes to safely deliver IV tPA in <45 minutes.
In the first 90 days, ED IV tPA times (N=16) dropped to 48.5 min, median 49.5 min.
The expedite-for-thrombolytic principle ‘to treat unless excluded’ aligns and assists in meeting the benchmarks identified in TS:2 (goal IV tPA <45 minute DTN). Additional research is needed to identify time-reducing means while improving patient stroke outcomes.
Author Disclosures: C.T. Bajkiewicz: None. M. Kalafut: None. L. Olson: None. K. Afshar: None.
- © 2015 by American Heart Association, Inc.