Multidisciplinary Approach to Decrease In-Hospital Delay for Stroke Thrombolysis
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Background and Purpose Decreasing the time delay for thrombolysis, including intravenousthrombolysis (IVT) with tissue plasminogen activator and intra-arterial thrombectomy (IAT), iscritical for decreasing the morbidity and mortality of patients experiencing acute stroke. Weaimed to decrease the in-hospital delay for both IVT and IAT through a multidisciplinary approachthat is feasible 24 h/day. Methods We implemented the Stroke Alert Team (SAT) on May 2, 2016, which introducedhospital-initiated ambulance prenotification and reorganized in-hospital processes. We comparedthe patient characteristics, time for each step of the evaluation and thrombolysis, thrombolysisrate, and post-thrombolysis intracranial hemorrhage from January 2014 to August 2016. Results A total of 245 patients received thrombolysis (198 before SAT; 47 after SAT). The mediandoor-to-CT, door-to-MRI, and door-to-laboratory times decreased to 13 min, 37.5 min, and 8 min,respectively, after SAT implementation (P<0.001). The median door-to-IVT time decreased from 46min (interquartile range [IQR] 36–57 min) to 20.5 min (IQR 15.8–32.5 min; P<0.001). The mediandoor-to-IAT time decreased from 156 min (IQR 124.5–212.5 min) to 86.5 min (IQR 67.5–102.3min; P<0.001). The thrombolysis rate increased from 9.8% (198/2,012) to 15.8% (47/297;P=0.002), and the post-thrombolysis radiological intracranial hemorrhage rate decreased from12.6% (25/198) to 2.1% (1/47; P=0.035). Conclusions SAT significantly decreased the in-hospital delay for thrombolysis, increasedthrombolysis rate, and decreased post-thrombolysis intracranial hemorrhage. Time benefits of SATwere observed for both IVT and IAT and during office hours and after-hours.
Abstract
Background and Purpose Decreasing the time delay for thrombolysis, including intravenousthrombolysis (IVT) with tissue plasminogen activator and intra-arterial thrombectomy (IAT), iscritical for decreasing the morbidity and mortality of patients experiencing acute stroke. Weaimed to decrease the in-hospital delay for both IVT and IAT through a multidisciplinary approachthat is feasible 24 h/day. Methods We implemented the Stroke Alert Team (SAT) on May 2, 2016, which introducedhospital-initiated ambulance prenotification and reorganized in-hospital processes. We comparedthe patient characteristics, time for each step of the evaluation and thrombolysis, thrombolysisrate, and post-thrombolysis intracranial hemorrhage from January 2014 to August 2016. Results A total of 245 patients received thrombolysis (198 before SAT; 47 after SAT). The mediandoor-to-CT, door-to-MRI, and door-to-laboratory times decreased to 13 min, 37.5 min, and 8 min,respectively, after SAT implementation (P<0.001). The median door-to-IVT time decreased from 46min (interquartile range [IQR] 36–57 min) to 20.5 min (IQR 15.8–32.5 min; P<0.001). The mediandoor-to-IAT time decreased from 156 min (IQR 124.5–212.5 min) to 86.5 min (IQR 67.5–102.3min; P<0.001). The thrombolysis rate increased from 9.8% (198/2,012) to 15.8% (47/297;P=0.002), and the post-thrombolysis radiological intracranial hemorrhage rate decreased from12.6% (25/198) to 2.1% (1/47; P=0.035). Conclusions SAT significantly decreased the in-hospital delay for thrombolysis, increasedthrombolysis rate, and decreased post-thrombolysis intracranial hemorrhage. Time benefits of SATwere observed for both IVT and IAT and during office hours and after-hours.
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