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Enhancing Access to tPA for Stroke

Enhancing Access to tPA for Stroke

Studies have shown that using tPA within 3 hours of stroke onset raises the chances for good outcomes in some patients who suffer one of these events, but this treatment is often underused. Although more than 11% of patients with stroke are eligible to receive tPA, studies show that 2% or less receive these important thrombolytics. Eliminating delays in the recognition and response to signs and symptoms of stroke could increase the proportion of tPA-eligible patients to as high as 24%. Designated stroke centers have improved the delivery of tPA, but less than one-quarter of patients in the United States live within 30 minutes of one of these centers. “The importance of early treatment for stroke cannot be overstated,” says Phillip A. Scott, MD. “Because of the short treatment window in which tPA can be given, many patients seek treatment at local community hospitals.” Unfortunately, neurologists are frequently unavailable for acute stroke care in community EDs. Furthermore, ED physicians often are hesitant to use thrombolytics due to time and resource issues or lack of experience with tPA. The INSTINCT Trial Few randomized controlled trials have tested practical interventions to increase tPA delivery for stroke patients in community hospitals. Identifying successful interventions could improve stroke care and serve as a model to enhance the adoption of other high-risk treatments. In an effort to increase tPA use in community hospital settings, the Increasing Stroke Treatment through Interventional Change Tactics (INSTINCT) trial was initiated in Michigan. The goal of INSTINCT was to assess the ability of a multilevel, barrier assessment-interactive educational intervention to increase tPA use in community hospitals, explains Dr. Scott,...
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