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ISC 2013: Improving Door-to-Needle Times

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The Particulars: Recent studies suggest that less than 30% of patients treated with intravenous tissue plasminogen activator (IV tPA) are imaged within 25 minutes or received IV tPA within 60 minutes of ED arrival. Using a model that incorporates all 10 best practices in the American Heart Association (AHA)’s Target Stroke Program may improve timeliness in administration of IV tPA for acute ischemic stroke (AIS) patients.

Data Breakdown: An analysis of ED door-to-CT and door-to-needle times in nearly 4,500 AIS patients found that times decreased significantly among tPA-treated patients following initiation of the AHA’s Target Stroke Program model. The percentage of patients with door-to-CT times of 25 minutes or less and door-to-needle times of 60 minutes or less doubled after the intervention. Calendar years was the only factor independently associated with achieving a door-to-needle time of 60 minutes or less.

Take Home Pearls: Implementation of a model based on the AHA’s Target Stroke Program appears to significantly improve door-to-CT and door-to-needle times for AIS patients. Improvement appears to be driven by hospital-level changes.

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