Reducing Door-to-Needle Time for Tissue Plasminogen Activator Administration in a Community Hospital: An Operations Study.

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From: Quality Management in Health Care(Vol. 29, Issue 4)
Publisher: Lippincott Williams & Wilkins, WK Health
Document Type: Report; Brief article
Length: 254 words

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Byline: Tyler Pitre, Michael G. DeGroote School of Medicine, McMaster University, Kitchener, Ontario, Canada.; Kyle Evans; Xinxin Tang; Adib Shamsuddin; Adhora Mir; Catherine Lee; Zaka Zia; Andrew P. Costa; Stephen Giilck Abstract BACKGROUND AND OBJECTIVES:: The benefit of tissue plasminogen activator (tPA) in acute ischemic stroke is time dependent. A 15-minute decrease in door-to-needle (DTN) time has been associated with increased odds of ambulating independently, faster discharge, and decreased odds of death. We investigated common causes of delay in DTN times in a community hospital setting in order to identify areas for improvement. METHODS:: A retrospective medical record review was conducted at a 574-bed community hospital. This included 100 patients who received tPA from 2016 to 2019. Time segments were classified a priori to reflect key work elements from the time between hospital arrival to tPA and recorded for each chart. Linear regression models were used to identify work elements associated with increased DTN time. RESULTS:: Median DTN time was 54:29 minutes. Linear regression analyses determined that differences in NIHSS score (P = .030), triage to computed tomography (CT) start (P = .017), triage to stroke physician page (P = .016), and CT report to tPA administration (P CONCLUSIONS:: The DTN time at our institution was above the recommended target. Our findings suggest that reducing the CT report time interval may decrease DTN time.

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Gale Document Number: GALE|A636844748