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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

Reducing door to needle time for stroke thrombolysis.

Sumanjit Gill¹

¹West Herts NHS Trust, England.

BMJ Quality Improvement Reports

|January 7, 2016

Summary

Rapid thrombolysis administration significantly improves stroke patient outcomes and reduces mortality. A complex intervention successfully reduced median door-to-needle times from 65.5 to 49 minutes.

Area of Science:

Neurology
Healthcare Management
Emergency Medicine

Background:

Rapid administration of thrombolysis is crucial for improving functional outcomes and reducing mortality in stroke patients.
Current UK targets aim for door-to-needle times of 45 minutes or less.
Implementing thrombolysis pathways, especially with telemedicine, presents multidisciplinary and logistical challenges.

Purpose of the Study:

To audit current stroke thrombolysis practices and map the existing pathway.
To identify barriers within the thrombolysis pathway and implement interventions to reduce door-to-needle times.
To evaluate the effectiveness of a complex intervention in improving stroke thrombolysis timeliness.

Main Methods:

Auditing current practice and mapping the existing thrombolysis pathway.

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Conducting an awareness campaign and implementing a multimodal intervention including ambulance pre-alerts, pathway revision, and staff education.

Auditing cases with long delays to identify systemic barriers and collaborating with stakeholders like ambulance services and A&E departments.

Main Results:

Median door-to-needle times decreased from 65.5 minutes to 49 minutes over an 18-month period.
The intervention demonstrated a significant reduction in door-to-needle times, meeting London performance standards.
Identified areas for further improvement include increased staffing and formal structures for discussing changes.

Conclusions:

A complex intervention effectively reduced door-to-needle times in stroke thrombolysis.
Achieving optimal outcomes requires rapid thrombolysis administration.
Further enhancements in staffing and process management can improve the efficacy of stroke thrombolysis pathways.