Abstract W P225: Twenty Seven Minute Average Door to Needle Time in a “Stroke Buckle” Emergency Department: Building on Target: Stroke Best Practice Strategies with Four Additional Strategies
Background: The time window for treatment of acute stroke with IV tPA is brief and with every minute wasted there is brain tissue lost. We used the 11 AHA/ASA Target: Stroke Best Practice Strategies and four additional care strategies to further streamline our acute stroke protocol.
Methods: From January 2014 to August 2014, 50 patients were treated with IV tPA at our medical center using a new stroke protocol instituting the 11 AHA/ASA Target: Stroke Best Practice Strategies with the addition of 4 strategies: 1) Stroke alert pages initiated by EMS transmitted critical information before patient arrival including a pre-screen for inclusion/exclusion criteria; 2) A standardized pre-stroke order set was enacted by the charge nurse immediately upon the patient arrival; 3) A dedicated “stroke bed” with all necessary stroke tools, stroke box, attached pump for tPA, and weighing capabilities accompanied the patient to CT behind EMS; 4) Patient assessment was initiated by the attending stroke neurologist immediately upon patient arrival in the ED ambulance bay or in the CT scanner. Results: Among the 50 patients, mean age was 65 (SD±14.69), 44.0% were female and mean presenting NIHSS was 11.3 (SD±9.20). The median DTN time was 26.5 minutes (IQR 20-34.5). Categorical DTN treatment times were between 1-20 minutes in 28% (14/50); between 21-30 minutes in 36% (18/50); between 31-60 minutes in 16% (8/50) and more than 60 minutes in 6% (3/50). Median onset of symptoms to treatment time was 78.50 minutes (IQR 56-104). The mean 24-hour post- tPA NIHSS was 4.1. Discharge disposition outcomes were favorable in 82%, including discharge to home in in 70% (35/50) and discharge to acute rehabilitation in 12% (6/50). Outcomes for ambulatory function at discharge were favorable in 84%, including independent ambulation in 70% and ambulation with assistance in 14%. Safety outcomes included sICH in 2% and in hospital mortality in 6%.
Conclusions: Implementation of Target: Stroke Best Practice Strategies plus the four additional care strategies enabled accelerated care with an average DTN time of 27 minutes. The expedited delivery of faster lytic therapy was associated with higher rates of excellent functional outcomes and a favorable safety profile.
Author Disclosures: A.V. Yallapragada: None. L. Benjamin: None. C. Neal: None. J. Saver: None.
- © 2015 by American Heart Association, Inc.