Effect of a revised thrombolysis protocol on the door-to-needle time in acute ischemic stroke patients: a quasi-experimental study

Abstract

Title: Effect of a revised thrombolysis protocol on the door-to-needle-time in acute ischemic stroke patients. Background: Intravenous thrombolysis treatment for acute ischemic stroke patients that can only be applied up to 4.5 hours within the onset of symptoms. Time from arrival at the hospital to start of thrombolytic treatment, “door-to-needle-time” is important to measure the quality of care. A revised thrombolysis protocol was introduced with an acute stroke team as part of this protocol to reduce the door-to-needle-time. Accuracy for activation of the acute stroke team is important because no activation of this team leads to undertriage. Aim: Evaluate the effect of the revised protocol on the door-to-needle-time and the accuracy of activations of this team. Method: A quasi-experimental pretest/post-test study was conducted on the emergency department in a regional hospital to compare the door-to-needle-time between the groups before and after implementation of the revised thrombolysis protocol and was analysed using descriptive statistics. Over- and undertriage rates of activation of the acute stroke team were calculated for the after group. Results: A reduction of the median door-to-needle-time of 17 minutes was found in the after group. A reduction in more than half of the time was observed in the subinterval CT-to-needle-time. The undertriage rate was 22.4% and the overtriage rate was 64.8% for activating the acute stroke team. Conclusion: The revised thrombolysis protocol has shown a significant reduction in the door-to-needle-time in patients who received intravenous thrombolytic therapy. A relatively high undertriage rate was found, which is important to reduce because it can worsen patient outcomes. The relatively high overtriage rate should be reduced without increasing the undertriage rate. Recommendations: Further research of the door-to-needle-time is needed when patients in the future are directly admitted at the CT-scan. Next to that, the reason for undertriage should be further explored.