Background and Purpose: IV tissue plasminogen activator (tPA) or alteplase is the only FDA-approved medication for acute ischemic stroke. For those eligible, it is recommended to be given within 60 minutes of ED arrival. Hospitals are recognized for more rapid delivery within 45 minutes as it is well reported that faster times correlate with improved functional outcomes. Apart from ED staff, a hospital stroke quarterback (neurologist or stroke RN), when available, responded to code strokes, orchestrated rapid interdepartmental flow, and served as a liason to EMS, bystanders and family, ED, Radiology, Telestroke and other and other team members. This study compared the effect of a stroke quarterback on Door-to-Needle (DTN) times and outcomes when compared to times when this added resource was not at bedside.
Methods: Utilizing data from a single facility’s Stroke tPA database, a retrospective data analysis was performed reviewing DTN times for all patients treated with IV alteplase from December 2015 to July 2017. Secondary measures included door to CT times, length-of-stay (LOS), Modified Rankin Scale (mRS) score at discharge and tPA related-complications. Data were analyzed using Mann Whitney U or chi-square tests, as appropriate. Significant results and associated p-values are reported.
Results: A total of 60 patients were included in the primary analysis, 61.7% (n=37) of patients were treated with a stroke quarterback at bedside, and 38.3 % (n=23) of cases were managed without. The median DTN with a stroke quarterback was 28.0 minutes [interquartile range (IQR)=19-36], whereas those managed without was 64.0 minutes [IQR=50-89] (U=78.5, p<.001). Fifty-four percent of patients treated with stroke quarterback met DTN times under 30 minutes. The median door to CT time was also significantly shorter (9 minutes [IQR=6-18] versus 18.5 minutes without [IQR=10-27] (U=213.5, p=.005). There were no significant differences in LOS, mRS or complications between the 2 groups.
Conclusion: The addition of a dedicated stroke team quarterback resulted in significantly shorter time to acute stroke treatment with thrombolysis. The majority of cases were treated in under 30 min