Three Easily-Implementable Changes Reduce Median Door-To-Needle Time for Intravenous Thrombolysis by 23 Minutes
Abstract Background:The benefit of intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) is time dependent. Despite great effort, the median door-to-needle time (DNT) was 60 minutes at the U.S. stroke centers. We investigated the effect of a simple quality improvement initiative on DNT for IVT. Methods: This is a single-center study of patients treated with IVT between 2013 and 2017. A simple quality improvement initiative was implemented in January 2015 to allow the Stroke team to manage hypertension in the emergency room, to make decision for IVT before getting blood test results unless patients were taking oral anticoagulants, and to give IV tPA in the CT suite. Baseline characteristics, DNT and outcomes at hospital discharge were compared between pre- and post-intervention groups. Results: Ninety and 136 patients were treated with IVT in pre- and post-intervention groups, respectively. The rate of IVT was significantly higher in the post-intervention group (20% vs. 14.4%, p=0.007).The median DNT with interquartile range (IQR) was reduced significantly by 23 minutes (63[53-81] versus 40[29-53],p<0.001) with more patients in the post-intervention group receiving IVT within 60 minutes (81.6% versus 46.7%) and 45 minutes (64.0% versus 17.8%). There was no significant difference in symptomatic intracerebral hemorrhage rate (1.5% vs 1.1%), functional independence at discharge (mRS 0-1, 29.4% vs 23.3), and hospital mortality (7.4% vs 6.7%) between the 2 groups. Conclusions:Three easily-implementable quality improvement initiative increases IVT rate and reduces DNT significantly. It is safe and can be easily adopted at other stroke centers.