BACKGROUND AND PURPOSE: Decreased door-to-needle (DTN) time with tissue plasminogen activator (tPA) for acute ischemic stroke is associated with improved patient outcomes. Emergency medicine pharmacists (EMPs) can expedite the administration of tPA by assessing patients for contraindications, preparing, and administering tPA. The purpose of this study was to determine the impact of EMPs on DTN times and clinical outcomes in patients with acute ischemic stroke who receive tPA in the emergency department. METHODS: A retrospective, single-center, cohort study of patients who received tPA between August 1, 2012, and August 30, 2014, was conducted to compare DTN times with or without EMP involvement in stroke care. Secondary outcomes included changes in neurological status as measured by the National Institutes of Health Stroke Scale (NIHSS), length of hospital stay, discharge disposition, symptomatic intracranial hemorrhage, and in-hospital all-cause mortality. RESULTS: A total of 100 patients were included. The EMPs were involved in the care of 49 patients. The EMP involvement was associated with a significant improvement in DTN time (median 46 [interquartile range IQR: 34.5-67] vs 58 [IQR: 45-79] minutes; P = .019) and with receiving tPA within 45 minutes of arrival (49% vs 25%, odds ratio [OR]: 2.81 [95% confidence interval [CI]: 1.21-6.52]). National Institutes of Health Stroke Scale scores were significantly improved at 24 hours post-tPA in favor of the EMP group (median NIHSS 1 [IQR: 0-4] vs 2 [IQR: 1-9.25]; P = .047). CONCLUSIONS: The EMP involvement in initial stroke care was associated with a significant improvement in DTN time.
BACKGROUND AND PURPOSE: Decreased door-to-needle (DTN) time with tissue plasminogen activator (tPA) for acute ischemic stroke is associated with improved patient outcomes. Emergency medicine pharmacists (EMPs) can expedite the administration of tPA by assessing patients for contraindications, preparing, and administering tPA. The purpose of this study was to determine the impact of EMPs on DTN times and clinical outcomes in patients with acute ischemic stroke who receive tPA in the emergency department. METHODS: A retrospective, single-center, cohort study of patients who received tPA between August 1, 2012, and August 30, 2014, was conducted to compare DTN times with or without EMP involvement in stroke care. Secondary outcomes included changes in neurological status as measured by the National Institutes of Health Stroke Scale (NIHSS), length of hospital stay, discharge disposition, symptomatic intracranial hemorrhage, and in-hospital all-cause mortality. RESULTS: A total of 100 patients were included. The EMPs were involved in the care of 49 patients. The EMP involvement was associated with a significant improvement in DTN time (median 46 [interquartile range IQR: 34.5-67] vs 58 [IQR: 45-79] minutes; P = .019) and with receiving tPA within 45 minutes of arrival (49% vs 25%, odds ratio [OR]: 2.81 [95% confidence interval [CI]: 1.21-6.52]). National Institutes of Health Stroke Scale scores were significantly improved at 24 hours post-tPA in favor of the EMP group (median NIHSS 1 [IQR: 0-4] vs 2 [IQR: 1-9.25]; P = .047). CONCLUSIONS: The EMP involvement in initial stroke care was associated with a significant improvement in DTN time.
Authors: Dariush Mozaffarian; Emelia J Benjamin; Alan S Go; Donna K Arnett; Michael J Blaha; Mary Cushman; Sandeep R Das; Sarah de Ferranti; Jean-Pierre Després; Heather J Fullerton; Virginia J Howard; Mark D Huffman; Carmen R Isasi; Monik C Jiménez; Suzanne E Judd; Brett M Kissela; Judith H Lichtman; Lynda D Lisabeth; Simin Liu; Rachel H Mackey; David J Magid; Darren K McGuire; Emile R Mohler; Claudia S Moy; Paul Muntner; Michael E Mussolino; Khurram Nasir; Robert W Neumar; Graham Nichol; Latha Palaniappan; Dilip K Pandey; Mathew J Reeves; Carlos J Rodriguez; Wayne Rosamond; Paul D Sorlie; Joel Stein; Amytis Towfighi; Tanya N Turan; Salim S Virani; Daniel Woo; Robert W Yeh; Melanie B Turner Journal: Circulation Date: 2015-12-16 Impact factor: 29.690
Authors: Kennedy R Lees; Erich Bluhmki; Rüdiger von Kummer; Thomas G Brott; Danilo Toni; James C Grotta; Gregory W Albers; Markku Kaste; John R Marler; Scott A Hamilton; Barbara C Tilley; Stephen M Davis; Geoffrey A Donnan; Werner Hacke; Kathryn Allen; Jochen Mau; Dieter Meier; Gregory del Zoppo; D A De Silva; K S Butcher; M W Parsons; P A Barber; C Levi; C Bladin; G Byrnes Journal: Lancet Date: 2010-05-15 Impact factor: 79.321
Authors: Gregg C Fonarow; Eric E Smith; Jeffrey L Saver; Mathew J Reeves; Adrian F Hernandez; Eric D Peterson; Ralph L Sacco; Lee H Schwamm Journal: Stroke Date: 2011-09-01 Impact factor: 7.914
Authors: Nicole M Acquisto; Daniel P Hays; Rollin J Terry Fairbanks; Manish N Shah; Joseph Delehanty; Flavia Nobay; Joseph Guido; Curtis E Haas Journal: J Emerg Med Date: 2010-09-02 Impact factor: 1.484
Authors: Gregg C Fonarow; Eric E Smith; Jeffrey L Saver; Mathew J Reeves; Deepak L Bhatt; Maria V Grau-Sepulveda; DaiWai M Olson; Adrian F Hernandez; Eric D Peterson; Lee H Schwamm Journal: Circulation Date: 2011-02-10 Impact factor: 29.690
Authors: Jamie N Brown; Connie L Barnes; Beth Beasley; Robert Cisneros; Melanie Pound; Charles Herring Journal: Am J Health Syst Pharm Date: 2008-02-15 Impact factor: 2.637
Authors: Werner Hacke; Geoffrey Donnan; Cesare Fieschi; Markku Kaste; Rüdiger von Kummer; Joseph P Broderick; Thomas Brott; Michael Frankel; James C Grotta; E Clarke Haley; Thomas Kwiatkowski; Steven R Levine; Chris Lewandowski; Mei Lu; Patrick Lyden; John R Marler; Suresh Patel; Barbara C Tilley; Gregory Albers; Erich Bluhmki; Manfred Wilhelm; Scott Hamilton Journal: Lancet Date: 2004-03-06 Impact factor: 79.321