Background & Objectives: Stroke is the fifth leading cause of death and the leading cause of disability in the U.S. Timely administration of IV alteplase, can lead to reduction in the severity of disability and improve patient outcomes. The American Heart Association and the American Stroke Association have focused community awareness efforts on the importance of calling 9-1-1 when stroke symptoms are present. Our objective is to determine if arrival mode, specifically arriving by Emergency Medical Services (EMS) vs. privately owned vehicle (POV), impacts timely administration of IV alteplase.
Methods: Get With the Guidelines (GWTG) -Stroke is a quality improvement initiative to improve care by promoting adherence to scientific guidelines. A retrospective review was conducted of 10,948 stroke patients from 261 hospitals using GWTG-Stroke in the Midwest from 2013 through 2015. Arrival mode, as well as IV alteplase administration times were analyzed.
Results: In 2013, the median arrival to IV alteplase administration (admin) time was 58 minutes (min) when arriving by EMS vs. 64 min when arriving by POV. In 2014, patients arriving by EMS had a median arrival to admin time of 54 min in comparison to 59 min when arriving by POV. In 2015, patients arriving by EMS had a median door to admin of IV alteplase time of 51 min, whereas patients arriving by POV arrival to IV alteplase median time was 58 min.
Conclusions: Midwest Stroke patients arriving by EMS received treatment of IV alteplase more timely than those that arrived by POV. Throughout the three years of this study, an average of 64.6% of patients arriving by EMS received IV alteplase within 60 min of hospital arrival in comparison to 52% of patients when arriving by POV. This demonstrates the collaboration, communication, and systems of care work being done by hospitals and EMS. With less than 40% of patients arriving by EMS, this data also identifies the continued need for community education regarding the importance of calling 9-1-1.