Abstract 2396: Barriers to Improve IV tPA Door to Needle Time-Comparing Small Rural Hospitals and Primary Stroke Centers

Abstract

Background and Issues- Stroke continues to be a significant cause of morbidity and mortality in Wisconsin. Research has shown improved outcomes when IV tPA is started as close as possible to the time the patient was last known well. Wisconsin has continued to work on the improvement of stroke systems of care through rural and urban initiatives and the awareness of time critical factors. Purpose- To evaluate the current state of compliance with factors known to increase the percentage of eligible patients receiving IV tPA within 60 minutes of arrival in both rural and urban settings. Methods- Two benchmarking groups were established in Wisconsin through the Get With The Guidelines online Patient Management tool. The Rural hospital benchmark includes an average of 21 hospitals and the Primary Stroke Center (PSC) group includes 24 hospitals. A total of 15,783 patient records between Q1 2008 and Q4 2010 were reviewed. Results- Both groups show similar barriers in getting IV tPA to the patient within 60 minutes of arrival. The measures that showed the greatest opportunity for improvement included pre-notification of an acute stroke from EMS to the receiving hospital allowing the hospital team to prepare and CT turnaround time. The rural group received pre-notification 64.8% between 2008 and 2010 and the PSC group at 66.1% during that same time frame. Another time critical factor is CT <= 25 minutes. The PSC group achieved that timeframe 21.9% of the time, doing slightly better than the rural group at 18.5%. Conclusions- Structured outreach activities utilizing national initiatives such as the American Heart Association’s Target: Stroke has highlighted the distance between the current situation and desired goal. This indicates the need to implement targeted QI programs, with follow up data collection to increase DTN <60. Specifically targeting small rural hospitals has increased awareness of the current barriers in administering IV tPA. Wisconsin hospitals in both benchmarks have committed to work on the identified measures, analyze progress and resolve specific barriers to timely IV tPA administration.