Use of Strategies to Improve Door-to-Needle Times with Tissue-Type Plasminogen Activator in Acute Ischemic Stroke in Clinical Practice: Findings from Target: Stroke

Ying Xian, Haolin Xu, Barbara Lytle, Jason Blevins, Eric D. Peterson, Adrian F. Hernandez, Eric E. Smith, Jeffrey L. Saver, Steven R. Messé, Mary Paulsen, Robert E Suter, Mathew J. Reeves, Edward C. Jauch, Lee H. Schwamm, Gregg C. Fonarow

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background - The implementation of Target: Stroke Phase I, the first stage of the American Heart Association's national quality improvement initiative to accelerate door-to-needle (DTN) times, was associated with an average 15-minute reduction in DTN times. Target: Stroke phase II was launched in April 2014 with a goal of promoting further reduction in treatment times for tissue-type plasminogen activator (tPA) administration. Methods and Results - We conducted a second survey of Get With The Guidelines-Stroke hospitals regarding strategies used to reduce delays after Target: Stroke and quantify their association with DTN times. A total of 16 901 ischemic stroke patients were treated with intravenous tPA within 4.5 hours of symptom onset from 888 surveyed hospitals between June 2014 and April 2015. The patient-level median DTN time was 56 minutes (interquartile range, 42-75), with 59.3% of patients receiving intravenous tPA within 60 minutes and 30.4% within 45 minutes after hospital arrival. Most hospitals reported routinely using a majority of Target: Stroke key practice strategies, although direct transport of patients to computed tomographic/magenetic resonance imaging scanner, premix of tPA ahead of time, initiation of tPA in brain imaging suite, and prompt data feedback to emergency medical services providers were used less frequently. Overall, we identified 16 strategies associated with significant reductions in DTN times. Combined, a total of 20 minutes (95% confidence intervals 15-25 minutes) could be saved if all strategies were implemented. Conclusions - Get With The Guidelines-Stroke hospitals have initiated a majority of Target: Stroke-recommended strategies to reduce DTN times in acute ischemic stroke. Nevertheless, certain strategies were infrequently practiced and represent a potential immediate target for further improvements.

Original languageEnglish (US)
Article numbere003227
JournalCirculation: Cardiovascular Quality and Outcomes
Volume10
Issue number1
DOIs
StatePublished - Jan 1 2017

Fingerprint

Tissue Plasminogen Activator
Needles
Stroke
Plasminogen Activators
Guidelines
American Heart Association
Emergency Medical Services
Quality Improvement
Neuroimaging
Confidence Intervals

Keywords

  • plasminogen activator
  • quality improvement
  • stroke
  • surveys
  • tissue

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Use of Strategies to Improve Door-to-Needle Times with Tissue-Type Plasminogen Activator in Acute Ischemic Stroke in Clinical Practice : Findings from Target: Stroke. / Xian, Ying; Xu, Haolin; Lytle, Barbara; Blevins, Jason; Peterson, Eric D.; Hernandez, Adrian F.; Smith, Eric E.; Saver, Jeffrey L.; Messé, Steven R.; Paulsen, Mary; Suter, Robert E; Reeves, Mathew J.; Jauch, Edward C.; Schwamm, Lee H.; Fonarow, Gregg C.

In: Circulation: Cardiovascular Quality and Outcomes, Vol. 10, No. 1, e003227, 01.01.2017.

Research output: Contribution to journalArticle

Xian, Y, Xu, H, Lytle, B, Blevins, J, Peterson, ED, Hernandez, AF, Smith, EE, Saver, JL, Messé, SR, Paulsen, M, Suter, RE, Reeves, MJ, Jauch, EC, Schwamm, LH & Fonarow, GC 2017, 'Use of Strategies to Improve Door-to-Needle Times with Tissue-Type Plasminogen Activator in Acute Ischemic Stroke in Clinical Practice: Findings from Target: Stroke', Circulation: Cardiovascular Quality and Outcomes, vol. 10, no. 1, e003227. https://doi.org/10.1161/CIRCOUTCOMES.116.003227
Xian, Ying ; Xu, Haolin ; Lytle, Barbara ; Blevins, Jason ; Peterson, Eric D. ; Hernandez, Adrian F. ; Smith, Eric E. ; Saver, Jeffrey L. ; Messé, Steven R. ; Paulsen, Mary ; Suter, Robert E ; Reeves, Mathew J. ; Jauch, Edward C. ; Schwamm, Lee H. ; Fonarow, Gregg C. / Use of Strategies to Improve Door-to-Needle Times with Tissue-Type Plasminogen Activator in Acute Ischemic Stroke in Clinical Practice : Findings from Target: Stroke. In: Circulation: Cardiovascular Quality and Outcomes. 2017 ; Vol. 10, No. 1.
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abstract = "Background - The implementation of Target: Stroke Phase I, the first stage of the American Heart Association's national quality improvement initiative to accelerate door-to-needle (DTN) times, was associated with an average 15-minute reduction in DTN times. Target: Stroke phase II was launched in April 2014 with a goal of promoting further reduction in treatment times for tissue-type plasminogen activator (tPA) administration. Methods and Results - We conducted a second survey of Get With The Guidelines-Stroke hospitals regarding strategies used to reduce delays after Target: Stroke and quantify their association with DTN times. A total of 16 901 ischemic stroke patients were treated with intravenous tPA within 4.5 hours of symptom onset from 888 surveyed hospitals between June 2014 and April 2015. The patient-level median DTN time was 56 minutes (interquartile range, 42-75), with 59.3{\%} of patients receiving intravenous tPA within 60 minutes and 30.4{\%} within 45 minutes after hospital arrival. Most hospitals reported routinely using a majority of Target: Stroke key practice strategies, although direct transport of patients to computed tomographic/magenetic resonance imaging scanner, premix of tPA ahead of time, initiation of tPA in brain imaging suite, and prompt data feedback to emergency medical services providers were used less frequently. Overall, we identified 16 strategies associated with significant reductions in DTN times. Combined, a total of 20 minutes (95{\%} confidence intervals 15-25 minutes) could be saved if all strategies were implemented. Conclusions - Get With The Guidelines-Stroke hospitals have initiated a majority of Target: Stroke-recommended strategies to reduce DTN times in acute ischemic stroke. Nevertheless, certain strategies were infrequently practiced and represent a potential immediate target for further improvements.",
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AU - Xian, Ying

AU - Xu, Haolin

AU - Lytle, Barbara

AU - Blevins, Jason

AU - Peterson, Eric D.

AU - Hernandez, Adrian F.

AU - Smith, Eric E.

AU - Saver, Jeffrey L.

AU - Messé, Steven R.

AU - Paulsen, Mary

AU - Suter, Robert E

AU - Reeves, Mathew J.

AU - Jauch, Edward C.

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AU - Fonarow, Gregg C.

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N2 - Background - The implementation of Target: Stroke Phase I, the first stage of the American Heart Association's national quality improvement initiative to accelerate door-to-needle (DTN) times, was associated with an average 15-minute reduction in DTN times. Target: Stroke phase II was launched in April 2014 with a goal of promoting further reduction in treatment times for tissue-type plasminogen activator (tPA) administration. Methods and Results - We conducted a second survey of Get With The Guidelines-Stroke hospitals regarding strategies used to reduce delays after Target: Stroke and quantify their association with DTN times. A total of 16 901 ischemic stroke patients were treated with intravenous tPA within 4.5 hours of symptom onset from 888 surveyed hospitals between June 2014 and April 2015. The patient-level median DTN time was 56 minutes (interquartile range, 42-75), with 59.3% of patients receiving intravenous tPA within 60 minutes and 30.4% within 45 minutes after hospital arrival. Most hospitals reported routinely using a majority of Target: Stroke key practice strategies, although direct transport of patients to computed tomographic/magenetic resonance imaging scanner, premix of tPA ahead of time, initiation of tPA in brain imaging suite, and prompt data feedback to emergency medical services providers were used less frequently. Overall, we identified 16 strategies associated with significant reductions in DTN times. Combined, a total of 20 minutes (95% confidence intervals 15-25 minutes) could be saved if all strategies were implemented. Conclusions - Get With The Guidelines-Stroke hospitals have initiated a majority of Target: Stroke-recommended strategies to reduce DTN times in acute ischemic stroke. Nevertheless, certain strategies were infrequently practiced and represent a potential immediate target for further improvements.

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