Improving the door-to-needle times (DNTs) for thrombolysis in acute ischemic stroke (AIS) patients improves outcomes. However, participation in DNT improvement initiatives have only been limited to academic, comprehensive medical centers with a pre-existing interest in stroke quality improvement. It is unknown whether quality improvement initiatives can improve DNT at a population level, including smaller community hospitals.
All AIS patients receiving thrombolysis in Alberta were included in the study. The quality improvement intervention involved interdisciplinary teams from each stroke center, participation in three workshops and closing celebration, feedback, data audit, webinars, and site visits. About 2488 AIS patients received thrombolysis in the post- and pre-intervention periods. The mean age was 71 years, and 46% of all patients were women. DNTs were reduced from a median of 70 minutes to 39 minutes for patients treated per guideline. The number of patients that were discharged home from acute care increased from 45% to 59%. The median 90-day home time increased from 43.3 days to 53.6 days.
As implemented in this study, the collaborative was most likely the key contributing factor in improving DNT across an entire population. The improvements to DNT have not been observed across an entire population before, and the Collaborative intervention implemented in this study can be successful in improving DNTs.
Ref: https://www.ahajournals.org/doi/10.1161/STROKEAHA.120.029734
