How a CT-Direct Protocol at an American Comprehensive Stroke Center Led to Door-to-Needle Times Less Than 30 Minutes

Abstract

Background and Purpose: The safety and efficacy of intravenous tissue plasminogen activator (IV tPA) following acute ischemic stroke (AIS) is dependent on its timely administration. In 2014, our Comprehensive Stroke Center designed and implemented a computed tomography-Direct protocol to streamline the evaluation process of suspected patients with AIS, with the aim of reducing door-to-needle (DTN) times. The objectives of our study were to describe the protocol development and implementation process, and to compare DTN times and symptomatic intracranial hemorrhage (sICH) rates before and after protocol implementation. Methods: Data were prospectively collected for patients with AIS receiving IV tPA between January 1, 2010, and May 31, 2015. The DTN times, examined as median times and time treatment windows, and sICH rates were compared pre-and postimplementation. Results: Two hundred ninety-five patients were included in the study. After protocol implementation, median DTN times were significantly reduced (38 vs 28 minutes; P < .001). The distribution of patients treated in the three time treatment windows described below changed significantly, with an increase in patients with DTN times of 30 minutes or less, and a decrease in patients with DTN times 31 to 60 minutes and over 60 minutes (P < .001). There were two cases of sICH prior to implementation and one sICH case postimplementation. Conclusions: The implementation of a protocol that streamlined the processing of suspected patients with AIS significantly reduced DTN time without negatively impacting patient safety.

Reducing care time after implementing protocols for acute ischemic stroke: a systematic review

“…Out of 35 articles included in this review, 34 (97.1%) 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 were published in English and one (2.9%) 46 in both English and Spanish. Regarding the origin of the selected studies, 15 (42.9%) studies were performed in the Americas, 13 17 18 21 22 24 26 30 31 37 38 39 40 44 45 10 (28.6%) in Europe, 14 15 20 23 27 29 32 34 35 46 7 (20.0%) in Asia, 12 19 25 28 33 36 43 and 3 (8.6%) in Oceania. 16 41 42 From the included articles, 15 (42.9%) were performed in the United States of America, 13 1...…”

“…Regarding the origin of the selected studies, 15 (42.9%) studies were performed in the Americas, 13 17 18 21 22 24 26 30 31 37 38 39 40 44 45 10 (28.6%) in Europe, 14 15 20 23 27 29 32 34 35 46 7 (20.0%) in Asia, 12 19 25 28 33 36 43 and 3 (8.6%) in Oceania. 16 41 42 From the included articles, 15 (42.9%) were performed in the United States of America, 13 17 18 21 22 24 26 30 31 37 38 39 40 44 45 4 (11.4%) in China, 12 25 36 43 3 (8.6%) in Australia, 16 41 42 2 (5.7%) in Japan, 19 33 2 (5.7%) in the Netherlands, 23 34 2 (5.7%) in Norway, 14 35 and 7 (20.0%) in varying countries 15 20 27 28 29 32 46 (…”

25 PciCall, emergency psychological assistance

“…2 We present the epidemiological characteristics of the population requesting medical attention to a private EMS identified by the telephone operator with activation of a Prehospital Stroke Code (PSC). Method Observational, retrospective, cross-sectional and descriptive study based on records made through the App Stroke Code v1.0 (internal development) from 01/09/2018 to 31/1/2019.…”

26 Patient outcome in the danish quality database for prehospital emergency medical services

“…Background Stroke is a time dependent medical emergency 1 that requires the coordinated action of the pre and in-hospital teams to improve the results. 2 …”