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Improving door-to-needle times in acute ischemic stroke: the design and rationale for the American Heart Association/American Stroke Association's Target: Stroke initiative.

Publication ,  Journal Article
Fonarow, GC; Smith, EE; Saver, JL; Reeves, MJ; Hernandez, AF; Peterson, ED; Sacco, RL; Schwamm, LH
Published in: Stroke
October 2011

BACKGROUND AND PURPOSE: The benefits of intravenous tissue-type plasminogen activator (tPA) in acute ischemic stroke are time-dependent, and guidelines recommend a door-to-needle time of ≤60 minutes. However, fewer than one third of acute ischemic stroke patients who receive tPA are treated within guideline-recommended door-to-needle times. This article describes the design and rationale of TARGET: Stroke, a national initiative organized by the American Heart Association/American Stroke Association in partnership with other organizations to assist hospitals in increasing the proportion of tPA-treated patients who achieve guideline-recommended door-to-needle times. METHODS: The initial program goal is to achieve a door-to-needle time≤60 minutes for at least 50% of acute ischemic stroke patients. Key best practice strategies previously associated with achieving faster door-to-needle times in acute ischemic stroke were identified. RESULTS: The 10 key strategies chosen by TARGET: Stroke include emergency medical service prenotification, activating the stroke team with a single call, rapid acquisition and interpretation of brain imaging, use of specific protocols and tools, premixing tPA, a team-based approach, and rapid data feedback. The program includes many approaches intended to promote hospital participation, implement effective strategies, share best practices, foster collaboration, and achieve stated goals. A detailed program evaluation is also included. In the first year, TARGET: Stroke has enrolled over 1200 United States hospitals. TARGET: Stroke, a multidimensional initiative to improve the timeliness of tPA administration, aims to elevate clinical performance in the care of acute ischemic stroke, facilitate the more rapid integration of evidence into clinical practice, and improve outcomes.

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Published In

Stroke

DOI

EISSN

1524-4628

Publication Date

October 2011

Volume

42

Issue

10

Start / End Page

2983 / 2989

Location

United States

Related Subject Headings

  • United States
  • Tissue Plasminogen Activator
  • Stroke
  • Quality Improvement
  • Program Evaluation
  • Program Development
  • Neurology & Neurosurgery
  • Humans
  • Fibrinolytic Agents
  • Emergency Medical Services
 

Citation

APA
Chicago
ICMJE
MLA
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Fonarow, G. C., Smith, E. E., Saver, J. L., Reeves, M. J., Hernandez, A. F., Peterson, E. D., … Schwamm, L. H. (2011). Improving door-to-needle times in acute ischemic stroke: the design and rationale for the American Heart Association/American Stroke Association's Target: Stroke initiative. Stroke, 42(10), 2983–2989. https://doi.org/10.1161/STROKEAHA.111.621342
Fonarow, Gregg C., Eric E. Smith, Jeffrey L. Saver, Mathew J. Reeves, Adrian F. Hernandez, Eric D. Peterson, Ralph L. Sacco, and Lee H. Schwamm. “Improving door-to-needle times in acute ischemic stroke: the design and rationale for the American Heart Association/American Stroke Association's Target: Stroke initiative.Stroke 42, no. 10 (October 2011): 2983–89. https://doi.org/10.1161/STROKEAHA.111.621342.
Fonarow, Gregg C., et al. “Improving door-to-needle times in acute ischemic stroke: the design and rationale for the American Heart Association/American Stroke Association's Target: Stroke initiative.Stroke, vol. 42, no. 10, Oct. 2011, pp. 2983–89. Pubmed, doi:10.1161/STROKEAHA.111.621342.
Fonarow GC, Smith EE, Saver JL, Reeves MJ, Hernandez AF, Peterson ED, Sacco RL, Schwamm LH. Improving door-to-needle times in acute ischemic stroke: the design and rationale for the American Heart Association/American Stroke Association's Target: Stroke initiative. Stroke. 2011 Oct;42(10):2983–2989.

Published In

Stroke

DOI

EISSN

1524-4628

Publication Date

October 2011

Volume

42

Issue

10

Start / End Page

2983 / 2989

Location

United States

Related Subject Headings

  • United States
  • Tissue Plasminogen Activator
  • Stroke
  • Quality Improvement
  • Program Evaluation
  • Program Development
  • Neurology & Neurosurgery
  • Humans
  • Fibrinolytic Agents
  • Emergency Medical Services