Abstract Details

Title An Interdisciplinary Intervention to Improve Time to Systemic Thrombolysis for Inpatient Acute Ischemic Strokes

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-014

Objective Identify barriers to inpatient alteplase administration and implement an interdisciplinary program to reduce time to systemic thrombolysis.

Background Compared to patients presenting to the emergency department with an acute ischemic stroke (AIS), inpatients are delayed in receiving alteplase (tPA) for systemic thrombolysis .

Design/Methods Institutional AIS metrics were abstracted from the electronic health records of patients presenting as an inpatient stroke alerts. All patients who received tPA for AIS were included in the analysis. A gap analysis was used to assess institutional deficiencies. An interdisciplinary program was initiated to address these deficiencies. Efficacy was measured with pre and post-intervention surveys and institutional AIS metrics analysis. Statistical significance was determined using Student’s t-test.

Results We identified 5 patients (median age 73; 61-82, 20% women, 80% white) who met inclusion criteria for the pre-intervention period (January 2017-December 2017), and 8 patients (median age 73; 51-93, 50% women, 87.5% white) post-intervention (October 2018-October 2019). Barriers were found to include tPA availability and provider bedside tPA compounding. Interdisciplinary intervention strategies included strategic tPA stocking on nursing floors, structured provider education, and provider hands-on tPA compounding simulations. ��ɫ�� and simulations improved provider confidence and proficiency. In the pre-intervention group, the median NIHSS before alteplase was 19 (2-24) compared to 14 (3-23) post-intervention. Post-intervention, the mean time from stroke alert to thrombolysis was shorter than pre-intervention (57.9 vs. 77.8 mins, p=0.043). Compared to pre-intervention, more patients at discharge post-intervention had mRS 0-2 (50 vs. 20%) and frequently went home or to rehab (100 vs. 60%)

Conclusions

A coordinated interdisciplinary approach is effective in reducing inpatient time to systemic thrombolysis in patients experiencing an AIS. While limited by small numbers, a trend was noted in good clinical outcomes with the shorter time. A similar program could be implemented at other hospitals to improve AIS metrics.

Authors/Disclosures
Harn Shiue, PharmD (Mayo Clinic Arizona Hospital) PRESENTER	Dr. Shiue has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Sara Dawit, MD	Dr. Dawit has nothing to disclose.
Kara A. Sands, MD (University of Alabama at Birmingham, Department of Neurology)	Dr. Sands has nothing to disclose.

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