Molly M Burnett1, Lara Zimmermann1, Zlatan Coralic1, Tina Quon1, William Whetstone1, Anthony S Kim2. 1. From the Departments of Neurology (M.M.B., L.Z., A.S.K.), Emergency Medicine (T.Q., W.W.), and Clinical Pharmacy (Z.C.), University of California, San Francisco. 2. From the Departments of Neurology (M.M.B., L.Z., A.S.K.), Emergency Medicine (T.Q., W.W.), and Clinical Pharmacy (Z.C.), University of California, San Francisco. akim@ucsf.edu.
Abstract
BACKGROUND AND PURPOSE: Timely administration of intravenous tissue-type plasminogen activator (IV tPA) is associated with improved outcomes for acute ischemic stroke; yet, developing processes to consistently provide prompt treatment remains a challenge. We developed and evaluated a simple quality improvement intervention designed to improve door-to-needle (DTN) times for resident-led Code Stroke teams at an academic medical center. METHODS: We evaluated a simple text-messaging based intervention with real-time feedback to improve DTN times for intravenous tissue-type plasminogen activator. We used the rank-sum test and linear regression to evaluate for a change in DTN times that was temporally associated with the rollout of the intervention. RESULTS: A total of 202 patients received intravenous tissue-type plasminogen activator; 94 preintervention and 108 postintervention. The median DTN time was significantly lower in the postintervention period (56 minutes [interquartile range 44-71] versus 82 minutes [IQR 68-103], P<0.0001) and a significantly higher proportion of patients were treated within 60 minutes (61% versus 16%, P<0.001). CONCLUSIONS: A simple real-time text-messaging intervention was associated with a significant improvements in DTN times for acute ischemic stroke.
BACKGROUND AND PURPOSE: Timely administration of intravenous tissue-type plasminogen activator (IV tPA) is associated with improved outcomes for acute ischemic stroke; yet, developing processes to consistently provide prompt treatment remains a challenge. We developed and evaluated a simple quality improvement intervention designed to improve door-to-needle (DTN) times for resident-led Code Stroke teams at an academic medical center. METHODS: We evaluated a simple text-messaging based intervention with real-time feedback to improve DTN times for intravenous tissue-type plasminogen activator. We used the rank-sum test and linear regression to evaluate for a change in DTN times that was temporally associated with the rollout of the intervention. RESULTS: A total of 202 patients received intravenous tissue-type plasminogen activator; 94 preintervention and 108 postintervention. The median DTN time was significantly lower in the postintervention period (56 minutes [interquartile range 44-71] versus 82 minutes [IQR 68-103], P<0.0001) and a significantly higher proportion of patients were treated within 60 minutes (61% versus 16%, P<0.001). CONCLUSIONS: A simple real-time text-messaging intervention was associated with a significant improvements in DTN times for acute ischemic stroke.
Authors: Sara K Rostanski; Joshua I Stillman; Lauren R Schaff; Crismely A Perdomo; Ava L Liberman; Eliza C Miller; Randolph S Marshall; Joshua Z Willey; Olajide Williams Journal: Neurohospitalist Date: 2017-01-17
Authors: Gaia T Koster; T Truc My Nguyen; Adrien E D Groot; Jonathan M Coutinho; Jan Bosch; Heleen M den Hertog; Marianne A A van Walderveen; Ale Algra; Marieke J H Wermer; Yvo B Roos; Nyika D Kruyt Journal: BMJ Open Date: 2018-06-27 Impact factor: 2.692