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Reduction in IV t-PA Door to Needle Times Using an Acute Stroke Triage Pathway

Published online by Cambridge University Press:  02 December 2014

M. Mehdiratta*
Affiliation:
Division of Neurology, Vancouver Hospital & Health Sciences Center
A.R. Woolfenden
Affiliation:
Division of Neurology, Vancouver Hospital & Health Sciences Center
K.M. Chapman
Affiliation:
Division of Neurology, St. Paul's Hospital, University of British Columbia,Vancouver, B.C., Canada
Dean C. Johnston
Affiliation:
Division of Neurology, St. Paul's Hospital, University of British Columbia,Vancouver, B.C., Canada
M. Schulzer
Affiliation:
Department of Medicine, Vancouver Hospital & Health Sciences Center
J. Beckman
Affiliation:
Division of Neurology, Vancouver Hospital & Health Sciences Center
P.A. Teal
Affiliation:
Division of Neurology, Vancouver Hospital & Health Sciences Center
*Corresponding
Vancouver Hospital Stroke Program, Doctors Residence, #214-2775 Heather Street, Vancouver, British Columbia, V5Z 3J5, Canada.
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Abstract:

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Objective:

To determine the effectiveness of an Acute Stroke Triage Pathway in reducing door to needle times in acute stroke treatment with IV t-PA.

Background:

A previous study at our tertiary referral centre, examining IV t-PA door to needle times, was completed in 2000. The median door to needle time was beyond the recommended National Institute for Neurological Disorders and Stroke (NINDS) standard of 60 minutes. In November 2001, an Acute Stroke Triage Pathway was introduced in the emergency room (ER) to address this issue. The goal of this pathway was to rapidly identify patients eligible for treatment for IV t-PA, so that CT scans and lab studies could be arranged immediately upon ER arrival. Our hypothesis was that the Triage Pathway would shorten door to CT and door to needle times.

Design/Methods:

Using retrospective data, pre (n=87) and post (n=47) triage pathway times were compared. The door to CT time was reduced by 11 minutes (p=0.015) and door to needle time was reduced by 18 minutes (p=0.0036) in a subgroup of patients that presented directly to our hospital.

Conclusions:

These results indicate that the Acute Stroke Triage Pathway is effective in reducing Door to CT and Door to Needle Times in patients presenting directly to our ER. However, a majority of treatment times were still beyond NINDS recommendations. Stroke Centers require periodic review of their efficiency to ensure that target times are being obtained and may benefit from the use of an Acute Stroke Triage Pathway.

Résumé:

RÉSUMÉ: Objectif:

Déterminer l’efficacité d’un système de triage de l’accident vasculaire cérébral aigu (AVC) pour diminuer le délai entre l’arrivée du patient et l’administration IV de t-PA.

Contexte:

Une étude antérieure effectuée dans notre centre de soins tertiaires pour évaluer le temps écoulé entre l’arrivée du patient et l’administration IV de t-PA a été complétée en 2000. Le temps médian entre l’arrivée et l’administration de t-PA était au-delà des 60 minutes recommandées par le National Institute of Neurological Disorders and Stroke (NINDS). En novembre 2001, une voiede triage de l’AVC a été implantée au service d’urgences pour corriger cette situation. Le but de cette voie était d’identifier rapidement les patients qui sont éligibles à ce traitement de telle sorte que la tomodensitométrie et les examens de laboratoire puissent être organisés dès l’arrivée au service d’urgences. Notre hypothèse était que la voie de triage réduirait le délai entre l’arrivée du patient et la tomodensitométrie et entre l’arrivée et l’administration de t-PA.

Plan/méthodes:

Il s’agit d’une étude rétrospective comparant le délai pré (n = 87) et post (n = 47) mise en vigueur de la voie de triage. Le temps écoulé de l’arrivée à la tomodensitométrie était diminué de 11 minutes ( p = 0,015) et de l’arrivée à l’administration de t-PA était diminué de 18 minutes (p = 0,0036) chez un sous-groupe de patients qui se sont présentés directement à notre hôpital.

Conclusions:

Ces resultants indiquent que la voie de triage de l’AVC est efficace pour diminuer le temps écoulé entre l’arrivée et la tomodensitométrie et le temps écoulé entre l’arrivée et l’administration de t-PA chez les patients qui se présentent directement à notre service d’urgences. Cependant dans la majorité des cas le temps était encore au-delà des recommandations du NINDS. Les centres spécialisés en AVC doivent effectuer une révision périodique de leur efficience pour s’assurer que les temps cibles sont atteints. Ces centres peuvent tirer profit de l’implantation d’une voie de triage de l’AVC.

Type
Original Articles
Copyright
Copyright © The Canadian Journal of Neurological 2006

References

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