Reducing delay to stroke thrombolysis--lessons learnt from the Stroke 90 Project

Area of Science:

• Emergency Medicine
• Neurology
• Healthcare Management

Background:

• The Stroke 90 Project aimed to decrease delays in administering thrombolysis for stroke patients across 7 hospitals and 2 ambulance services.
• Key interventions included a direct to CT (DtoCT) protocol for paramedics, enabling direct patient transport to CT scanners.
• The project coincided with significant winter pressures on participating emergency departments.

Purpose of the Study:

• To evaluate the effectiveness of a direct to CT (DtoCT) protocol in reducing delays to stroke thrombolysis.
• To assess the impact of the DtoCT pathway on various time metrics, including ambulance transport, door to CT, and door to needle times.

Main Methods:

• A comparative analysis of pre-intervention (n=136) and post-intervention (n=215) stroke patients undergoing thrombolysis between August 2012 and January 2013.
• Statistical analysis included chi-squared tests, t-tests, and multiple/linear regression to compare outcomes between the two groups.

Main Results:

• The DtoCT pathway was utilized by 44% of post-intervention patients.
• A significant increase in thrombolysis within 90 minutes of call for help was observed (11.7% pre-intervention vs. 23.7% post-intervention, p=0.0135).
• The DtoCT pathway reduced door to CT time by a mean of 17 minutes (p<0.0001) and door to needle time by 19 minutes (p<0.0001).

Conclusions:

• The direct to CT pathway proved successful in reducing delays to thrombolysis and is recommended for routine implementation.
• Call to door and CT to needle times were not significantly improved, indicating a need for further streamlining efforts.
• Local hospital-level changes can mitigate treatment delays, even when external factors are challenging.