Background: National guidelines recommend door-to-needle (DTN) time ≤ 60 minutes for patients with acute ischemic stroke (AIS). American Heart Association’s Target: Stroke initiative has identified several evidence-based best practices associated with optimal DTN times. In 2009, the state of Illinois passed legislation to establish a statewide stroke system of care, and updated it in 2014 to recognize three tiers of stroke designations - Acute Stroke Ready Hospital (ASRH), Primary Stroke Center (PSC), and Comprehensive Stroke Center (CSC) - to promote equitable access to these evidence-based stroke practices for all residents of Illinois. The ASRH designation ensures that patients with acute stroke receive essential recommended care at the entry point of care. As part of formal designation, ASRHs are required to submit stroke quality outcomes to the state demonstrating adherence to recommended guidelines for acute stroke care at the entry point of care. Prior to legislation, these hospitals were not required to submit data. The impact of ASRH designation on DTN best practice implementation has not been well studied.
Methods: We performed a retrospective study of a state-wide stroke quality improvement database, the Get With the Guidelines (GWTG)-Stroke registry for Illinois Critical Access Hospital Network participating hospitals from 2009-2017. De-identified records for patients with confirmed stroke from 2009-2017 presenting to Illinois-designated ASRH were included for analysis. Excel was used for analysis, and descriptive statistics are presented.
Results: A total of 33 ASRH-designated hospitals in Illinois participated in the GWTG Illinois Critical Access Hospital benchmark during the study period. Included patients and treatment characteristics are listed in the Table along with performance in key best practice areas: Median DTN Times and Door to CT < 25 minutes.
Conclusions: Since Illinois introduced ASRH designation in 2009, a steady improvement in meeting acute stroke benchmarks has been observed for hospitals providing care at the entry point of care. Statewide stroke legislation should be considered as a strategy for supporting system-wide implementation of acute stroke best practices.