Hospital-based intervention to reduce tPA administration time

Abstract

Objective: Ischemic strokes cause significant morbidity and mortality. Treatment with tissue plasminogen activator (tPA) is an important step to achieve reperfusion and minimize neuronal loss for those patients that qualify. Multiple studies have shown that there is a direct correlation between the timeliness of tPA administration after infarction has begun and improved health outcomes. Hospital process related barriers to tPA administration increase the time from the onset of stroke to treatment, leading to worse outcomes. Patients and methods: This retrospective review from a single stroke center looked at stroke patients across three years (July 2014–May 2017) and examined the temporal delay to treatment that potentially stemmed from the fact that tPA was given after transfer from the radiology suite (post-CT scan) back to the emergency department. This order of events is commonplace in stroke centers across the US. Results: Our results indicate there is a significant 26 minute delay with the commonly used protocol where tPA is given, not in the CT scanner, but rather after the scan when patients return to the emergency room. Conclusion: Our results imply that a change in the protocol (direct administration of tPA in the radiology suite) could improve health outcomes by decreasing the delay in tPA administration. Keywords: Stroke, tPA, Barriers to treatment, Vascular neurology, Quality improvement, Vascular neurosurgery