Integrating thrombolysis into routine stroke care in a Ghanaian tertiary hospital, using the implementation research...

Despite bearing the brunt of the global burden of post-stroke disability, cost-effective acute treatments such as stroke thrombolysis remain significantly underutilized in Low- and Middle-Income Countries. Pragmatic implementation strategies tailored to the local contexts could bridge the gap between evidence and practice and potentially improve access in these regions.

To assess the effectiveness of a multicomponent implementation strategy in improving access and timeliness of stroke thrombolysis in a Ghanaian tertiary hospital.

We conducted a pre- and post-implementation analysis after rolling out a 3-pronged implementation strategy to facilitate the incorporation of stroke thrombolysis into routine stroke care at the Komfo Anokye Teaching Hospital. This strategy was guided by the Implementation Research Logic Model, targeting multiple contextual barriers in tandem across multiple stakeholders. It entailed a public awareness campaign, establishment of a multidisciplinary stroke team with code-driven stroke protocols, and cost mitigation strategies. The pre-implementation needs assessment was from November 2022 to April 2023, while the implementation phase was from February 2024 to August 2024.

Compared to the pre-implementation phase, the thrombolysis eligibility rate rose from 7.9% to 9.5%, p = 0.581, while the stroke thrombolysis rate increased from 0.83% (2 out of 242) to 4.03% (14 out of 347) during the implementation phase, p = 0.020. Regarding timeliness, 13.5% arrived within 3 h of stroke onset in the implementation phase compared to 5.6% during the pre-implementation period, p = 0.000. The average door-to-needle time was 1 h, 48 min, which was faster compared to 2 h, 37 min in the pre-implementation phase, p = 0.000. Access to intravenous thrombolysis was equitably distributed irrespective of the patient's socio-demographics.

Our findings highlight the potential of contextually tailored implementation strategies, embedded in a structured implementation framework, to improve access to stroke thrombolysis even in resource-constrained settings. These findings provide a template for the implementation of stroke services in the sub-region.