Journal article
Improvement in Door-to-Needle Time in Patients with Acute Ischemic Stroke via a Simple Stroke Activation Protocol
Journal of stroke and cerebrovascular diseases, Vol.27(6), pp.1539-1545
06/2018
DOI: 10.1016/j.jstrokecerebrovasdis.2018.01.005
PMID: 29422380
Abstract
In acute ischemic stroke (AIS), treatment with intravenous tissue-type plasminogen activator (IV-tPA) is time-sensitive. All stroke centers make continual efforts to reduce door-to-needle time (DNT) with varying success. We present the impact of modifications to our stroke activation protocol on DNT.
We included 404 consecutive patients with AIS receiving IV-tPA between January 2014 and December 2016. First changes in stroke activation protocol were made in March 2015 in the form of prenotification by paramedics, direct transfer from ambulance to computed tomography (CT) scanner, and rapid en route neurological assessment by an emergency physician and neurologist. In March 2016, a second amendment was made where a stroke nurse accompanied the patient to expedite various steps in the treatment pathway, including endovascular treatment in eligible cases.
Both protocol amendments resulted in improvement in DNT and door-to-CT time from 84 ± 47 minutes before intervention to 69 ± 33 minutes after protocol amendment 1 to 59 ± 37 minutes after protocol amendment 2. In particular, the second amendment (144 patients) showed significant shortening of DNT compared with the 137 patients before (59 ± 37 minutes versus 69 ± 33 minutes, P = .020), with a higher percentage achieving the target of 60 minutes (68.1% versus 48.2%, P < .001). This finding was attributed to a reduction in both door-to-CT time and CT-to-needle time. This improvement remained consistent over subsequent months.
The application of a simple systems-based, multidisciplinary stroke activation protocol may help in significant reduction in DNT. Encouraging increased patient ownership by stroke nurses appeared to be a promising approach for timely administration of definitive acute therapies.
Details
- Title: Subtitle
- Improvement in Door-to-Needle Time in Patients with Acute Ischemic Stroke via a Simple Stroke Activation Protocol
- Creators
- Benjamin Y.Q. Tan - National University Health SystemNicholas J.H. Ngiam - Division of Neurology, Department of Medicine, National University Health System, Singapore, SingaporeSibi Sunny - National University Health SystemWan Yee Kong - National University Health SystemHowen Tam - National University Health SystemTiong Beng Sim - National University Health SystemBenjamin S.H. Leong - National University Health SystemChandra Bhartendu - National University Health SystemPrakash R. Paliwal - National University Health SystemRaymond C.S. Seet - National University Health SystemBernard P.L. Chan - National University Health SystemHock Luen Teoh - National University Health SystemVijay K. Sharma - Division of Neurology, Department of Medicine, National University Health System, Singapore, SingaporeLeonard L.L. Yeo - Karolinska University Hospital
- Resource Type
- Journal article
- Publication Details
- Journal of stroke and cerebrovascular diseases, Vol.27(6), pp.1539-1545
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.jstrokecerebrovasdis.2018.01.005
- PMID
- 29422380
- ISSN
- 1052-3057
- eISSN
- 1532-8511
- Language
- English
- Date published
- 06/2018
- Academic Unit
- Stead Family Department of Pediatrics; Medical Genetics and Genomics
- Record Identifier
- 9984354053002771
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