Abstract Details

Title Louisiana’s Level III Stroke Center Performance Improvement Progress

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-068

Objective We sought to evaluate trends in thrombolytic treatment in Louisiana.

Background In 2014, Level III stroke centers initiated voluntary submission of quarterly emergency department stroke data to Louisiana Emergency Response Network. The dataset includes all patients presenting with suspected stroke and the stroke code times for those who arrived within 2hrs of onset. Hospitals receive constructive feedback reports. Data submission became mandatory in Q1 2018. Failure to meet efficiency standards after action plan requirements now carries the risk of losing Level III stroke center status.

Design/Methods Data was received Q1 2014 through Q2 2018 with 100% compliance of the 54 Level III sites in 2018. The treatment rate and efficiency with thrombolytic, reasons for not offering treatment and reasons for delay in treatment were analyzed.

Results The overall thrombolytic treatment rate among 6576 cases was 10.9% with no significant change over time. The median door-to-needle (DTN) time reduced from 76 to 58 minutes. In 2018, a patient was 3.26x more likely to have DTN </=60 minutes compared to 2014. The most common reasons for prolonged DTN were: hypertension (23.3%), timeline evolved (16.7%), consent process (15.0%), and further imaging (13.3%). In 2018, the most common reasons for not treating a patient who presented within 2 hours of LSN were: symptoms resolved (34.6%, increasing), no reason documented (15.2%, decreasing), stroke mimic (12.7%, increasing), hemorrhage on CT (7.8%, stable), coagulopathy (6.5%, increasing), and minimal deficits (5.4%, decreasing).

Conclusions Thrombolytic treatment rates, while fairly static, are higher than the published rate among primary stroke centers nationally. Minimal deficits and failure to document a reason for not treating are reducing in frequency over time. The efficiency of treatment has improved over time, but targets for further reduction in DTN include earlier anticipation of blood pressure lowering and the consent process.

Authors/Disclosures
Sheryl Martin-Schild, MD, PhD, FAAN (Dr. Brain, Inc.) PRESENTER	No disclosure on file
Digvijaya D. Navalkele, MD (Emory University)	Dr. Navalkele has nothing to disclose.
Ramy El Khoury, MD, FAAN (Neuro Care of Louisiana)	No disclosure on file
Oleg Y. Chernyshev, MD, PhD, FAAN (LSUHSC-Shreveport)	Dr. Chernyshev has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file

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