Journal article
Assessing the impact of emergency medicine pharmacists on fibrinolytic door-to-needle times in acute ischemic stroke: A systematic review and meta-analysis (Pharmacist-assisted Stroke Treatments I (PhAST-1))
The American journal of emergency medicine, Vol.98, pp.57-64
12/2025
DOI: 10.1016/j.ajem.2025.08.014
PMID: 40840401
Abstract
Acute ischemic stroke (AIS) requires time-sensitive fibrinolytic therapy measured by door-to-needle (DTN) time. Emergency medicine pharmacists (EMPs) are integral in emergency departments (EDs) for optimizing AIS care as they possess expertise in drug therapy and emergency response.
The purpose of this systematic review and meta-analysis (SR/MA) is to evaluate EMP impact on DTN time.
This SR/MA searched multiple databases. Eligibility criteria included adult ED patients with AIS receiving fibrinolytics with defined EMP involvement. The primary endpoint was fibrinolytic DTN time. Secondary endpoints included achievement of timely fibrinolytic and length of stay (LOS). Meta-analysis was conducted using random-effects models.
Of 494 total citations identified, 214 citations met screening criteria with 22 studies undergoing full text review and 9 observational, retrospective, cohort studies included. A total of 1064 patients were included for MA with 441 (41.4 %) in the EMP present group and 623 (58.6 %) in the EMP absent group. EMP presence was associated with reduced mean DTN time by 14.6 min (95 % CI -18.1, −11.1 min). Odds of achieving a DTN within 60- and 45-min was higher with EMP presence, OR 2.85 (95 % CI 1.40, 5.79) and 2.75 (95 % CI 1.99, 3.79), respectively. ICU LOS was longer by 2.07 days in the EMP present group, but hospital LOS was not different between groups.
EMP presence during AIS management is associated with a reduction in fibrinolytic DTN time compared to no EMP presence. These findings highlight the importance of EMPs in optimizing patient outcomes related to stroke care.
•Timely fibrinolytic administration is essential in acute ischemic stroke, and door-to-needle (DTN) time is a key quality metric in emergency care.•This systematic review and meta-analysis is the first to evaluate the impact of emergency medicine pharmacists (EMPs) on DTN times.•EMP involvement was associated with significantly reduced DTN times and improved odds of meeting 60- and 45-min benchmarks for fibrinolytic delivery.•Findings support the integration of EMPs into emergency stroke teams and may inform ED staffing models and acute stroke protocols.
Details
- Title: Subtitle
- Assessing the impact of emergency medicine pharmacists on fibrinolytic door-to-needle times in acute ischemic stroke: A systematic review and meta-analysis (Pharmacist-assisted Stroke Treatments I (PhAST-1))
- Creators
- Kevin J. Mercer - The University of Texas at AustinGavin T. Howington - University of KentuckyCaitlin S. Brown - Mayo ClinicBrian W. Gilbert - Wesley Medical CenterKristin Cole - Mayo ClinicNicole M. Acquisto - University of Rochester Medical CenterDavid E. Zimmerman - Duquesne UniversityLance Ray - Denver Health Medical CenterDana Gerberi - Mayo ClinicAlicia Mattson - Mayo ClinicBrett Faine - University of Iowa College of Pharmacy, 180 S Grand Ave, Iowa City, IA 52242, United StatesMegan A. Rech - Edward Hines, Jr. VA HospitalEMPHARM-NET Collaborators
- Resource Type
- Journal article
- Publication Details
- The American journal of emergency medicine, Vol.98, pp.57-64
- DOI
- 10.1016/j.ajem.2025.08.014
- PMID
- 40840401
- NLM abbreviation
- Am J Emerg Med
- ISSN
- 0735-6757
- eISSN
- 1532-8171
- Publisher
- Elsevier Inc
- Language
- English
- Electronic publication date
- 08/2025
- Date published
- 12/2025
- Academic Unit
- Emergency Medicine; Pharmacy Practice and Science
- Record Identifier
- 9984946699402771
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