Strategies used by hospitals to improve speed of tissue-type plasminogen activator treatment in acute ischemic stroke


Journal Article

BACKGROUND AND PURPOSE-: The benefits of intravenous tissue-type plasminogen activator in acute ischemic stroke are time dependent, and several strategies have been reported to be associated with more rapid door-to-needle (DTN) times. However, the extent to which hospitals are using these strategies and their association with DTN times have not been well studied. METHODS-: We surveyed 304 Get With The Guidelines-Stroke hospitals joining Target: Stroke regarding their baseline use of strategies to reduce DTN times in the January 2008 to December 2009 time frame before the initiation of Target: Stroke and determined the association between hospital strategies and DTN times. RESULTS-: Among 5460 patients receiving tissue-type plasminogen activator within 3 hours of symptom onset in surveyed hospitals, the median DTN time was 72 minutes (interquartile range, 55-94). Reported use of the different strategies varied considerably. Of 11 hospital strategies analyzed individually by multivariable analysis, 3 strategies were independently associated with shorter DTN times. These included rapid triage/stroke team notification (209/304 [69%] hospitals, 8.1-minute reduction in DTN time), single-call activation system (190/304 [63%] hospitals, 4.3 minutes), and tissue-type plasminogen activator stored in the emergency department (189/304 [62%] hospitals, 3.5 minutes). When analyzed incrementally, hospitals that used a greater number of strategies had shorter DTN times with 1.3 minutes (adjusted mean difference) saved for each strategy implemented (14 minutes if all strategies were used). CONCLUSIONS-: Although the majority of participating hospitals reported using some strategy to reduce delays in tissue-type plasminogen activator administration for acute ischemic stroke, the strategies applied vary considerably and those most strongly associated with shorter DTN times were applied relatively less frequently. © 2014 American Heart Association, Inc.

Full Text

Duke Authors

Cited Authors

  • Xian, Y; Smith, EE; Zhao, X; Peterson, ED; Olson, DM; Hernandez, AF; Bhatt, DL; Saver, JL; Schwamm, LH; Fonarow, GC

Published Date

  • January 1, 2014

Published In

Volume / Issue

  • 45 / 5

Start / End Page

  • 1387 - 1395

Electronic International Standard Serial Number (EISSN)

  • 1524-4628

International Standard Serial Number (ISSN)

  • 0039-2499

Digital Object Identifier (DOI)

  • 10.1161/STROKEAHA.113.003898

Citation Source

  • Scopus