Background: The benefits of intravenous tissue plasminogen activator (IV tPA) in acute ischemic stroke are time-dependent. The implementation of Target: Stroke Phase I, the first stage of the American Heart Association’s national quality improvement initiative to accelerate door-to-need (DTN) times, was associated with an average 15 minutes reduction in DTN times. To further reduce DTN delays, Target: Stroke Phase II was launched in 2014 and disseminated additional new best practice strategies.
Methods: All active Get With The Guidelines-Stroke hospitals (n=1701) were invited to participate in Target: Stroke Phase II and completed an online survey regarding their use of DTN strategies. Hospital respondents reported the use of specific strategies in the 6 months preceding the survey as a binary yes/no or a continuous 0 to 100% of the time scale.
Results: A total of 1034 hospitals (61% response rate) completed the survey between Dec 2014 and Apr 2015. The majority of participating hospitals reported routine use of Target: Stroke key practice strategies, although direct transfer to CT scanner, point of care testing, pre-mix of tPA ahead of time, tPA stored in Emergency Department (ED), or initiation of tPA bolus in the imaging suite were used less frequently (Table). Brain imaging located within the ED was reported by 44% of hospitals and 78% had access to an in-house stroke expert 24/7. Among those who did not have stroke expertise at all times, a majority of hospitals used telestroke systems for imaging interpretation (78%) or clinical evaluation (58%).
Conclusions: GWTG-Stroke hospitals reported moderate to extensive use of most Target: Stroke key practice strategies to evaluate acute stroke cases for tPA eligibility and reduce DTN times. Nevertheless, use of point of care testing, pre-mixing of tPA, ED storage of tPA, initiation of tPA in the imaging suite, and direct transfer to CT scanner remained low, representing potential targets for additional improvements.