Efforts to reduce the door-to-needle time of thrombolysis in acute ischemic stroke: Video-assisted therapeutic risk communication

Abstract

Explaining the risks and benefits of recombinant tissue-plasminogen activator (rtPA) to eligible patients with acute ischemic stroke (AIS) within a few minutes is important but difficult. We examined whether a new thrombolysis program can decrease the door-to-needle (DTN) time when treating patients with AIS. Methods: A new rtPA thrombolysis program with video assistance was adapted for patients with AIS and their families. We retrospectively compared outcome quality before (2009–2011) and after (2012) the program began. Outcomes included DTN time, the percentage of rtPA thrombolysis within 3 hours of onset in all hospitalized patients with AIS who presented within 2 hours of onset (2hr%) and the percentage of rtPA thrombolysis in all hospitalized patients with AIS (AIS%). Results: We recruited patients with AIS who had undergone thrombolytic therapy before (n = 18) and after (n = 14) the initiation of the new program. DTN time decreased (93 ± 24 minutes to 57 ± 14 minutes, p < 0.001) and the AIS% increased (2% to 5%, p = 0.010) after the program. The 2hr% marginally significantly increased (18% to 33%, p = 0.080). Conclusion: A thrombolysis program with video-assisted therapeutic risk communication decreased DTN time and increased the treatment rate of patients with AIS.

Keywords

• cerebral infarction
• emergency medicine
• plasminogen activators
• thrombolytic therapy