Abstract Details

Title Developing a process for IV tPA door-to-needle administration in 30 minutes or less; a multidisciplinary approach

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P3 - Poster Session 3 (12:00 PM-1:00 PM)

Poster/Presentation
Number 4-008

Objective N/A

Background Early reperfusion is a cornerstone of therapy for acute ischemic stroke. Guidelines emphasize early delivery of IV tPA. Door-to-needle (DTN) time is also important in the pathway to mechanical thrombectomy. We aimed to revise our delivery techniques to achieve average DTN time of ≤ 30 minutes in eligible patients, hence improving functional outcomes upon hospital discharge.

Design/Methods

We established a multidisciplinary team representing all members of the care team involved in the IV tPA process. We determined goal timeframes for the subcomponents of the process. A fishbone diagram was used to identify barriers. Subgroups each focused on a specific category. All team members received monthly feedback. Eligible patients included those meeting GWTG criteria for IV tPA.

Results Four main areas were identified for subgroup intervention: scan interpretation; documentation and communication; location of tPA administration; completion of ancillary tasks prior to tPA. Quarterly average DTN times were reduced from 56.1 to 26.4 minutes over a period of 18 months for all patients and 54.6 to 26.1 minutes for eligible patients during the same period. There was a 20% increase in IV tPA delivery during this period, and a sustained average DTN time of ≤ 30 minutes across 6 months in 2018. No change was observed in symptomatic intracranial hemorrhage rate.

Conclusions Average door-to-needle time of ≤ 30 minutes for acute ischemic stroke is possible and likely sustainable. A multidisciplinary approach with focus groups and an emphasis on teamwork and collaboration is important to develop a successful process.

Authors/Disclosures
Sumaiya Khondker, MD (Hamilton Medical Center) PRESENTER	No disclosure on file
Marc A. Lazzaro, MD	No disclosure on file

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