Background: Baptist Health System (BHS) became Primary Stroke Certified in May, 2009. BHS admits approximately 2,000 stroke patients annually. Applying LEAN methodology and the AHA/ASA Target Stroke Best Practice Strategies, BHS initially obtained the Target Stroke Honor Roll status in 2010 and continues to sustain this status. With the addition of Target Stroke Elite and Elite Plus awards, we have re-focused on our Door-to-Needle (D2N) times. The purpose of this review is to evaluate the effectiveness of our D2N initiative of < 60 minutes, whether the patient arrives by EMS or Private Vehicle (PV).
Methods: A retrospective review was conducted of AIS patients who received IV tPA between 2008 and 2014 using GWTG data. The intent of the review was to compare annual results of the mode of arrival (EMS versus PV) and the percent of patients who received tPA with a D2N time of < 60 minutes.
Results: Between 2008 and 2014, BHS administered tPA to 688 AIS patients. Of these patients, an average of 84% arrived by EMS and 16% by PV annually. Data revealed that prior to stroke certification 31 patients received tPA. Only one (3.2%) of the 31 patients, who arrived by EMS, received tPA < 60 minutes. The year BHS became stroke certified tPA was administered to 63 patients. Of those 63, two patients received tPA < 60 minutes; one arrived by EMS (14.3%) and one arrived by PV (1.8%). Since the implementation of Target Stroke Best Practice Strategies in 2010, tPA administration ranged from 113 - 127 patients the following years. The D2N goal of < 60 minutes was achieved an average of 53.6 % when arriving by EMS and an average of 36.3% when arriving by PV. Although arrival modes did not vary significantly, there was a noted increase in D2N time of < 60 minutes in patients arriving by PV between 2013 at 22.7% and 2014 at 47.4%
Conclusion: Patients arriving by EMS have historically had a faster tPA administration time than patients arriving by PV. There is a marked improvement in D2N times in patients arriving by PV with the introduction of the Target Stroke Elite and Target Stroke Elite Plus initiative and a refocus on D2N time in this hospital system.