Article

OBJECTIVE: To determine the effects of a 1-year quality-improvement (QI) process
to reduce door-to-needle (DTN) time in a secondary general hospital in which
multimodal MRI screening is used before tissue plasminogen activator (tPA)
administration in patients with acute ischemic stroke (AIS). METHODS: The QI
process was initiated in January 2015. Patients who received intravenous (iv)
tPA<4.5h after AIS onset between 26 February 2015 to 25 February 2016 (during
implementation of the QI process; the "2015 cohort") were identified (n=130), and
their demographic and clinical characteristics and timing metrics compared with
those of patients treated by iv tPA in 2014 (the "2014 cohort", n=135). RESULTS:
Of the 130 patients in the 2015 cohort, 120 (92.3%) of them were screened by MRI.
The median DTN time was significantly reduced by 30% (from 84min in 2014 to
59min; P<0.003), while the proportion of treated patients with a DTN time</=60min
increased from 21% to 52%
(P<0.0001). Demographic and baseline characteristics
did not significantly differ between cohorts, and the improvement in DTN time was
associated with better outcomes after discharge (patients with a 0-2 score on the
modified rankin scale: 59% in the 2015 cohort vs 42.4% in the 2014 cohort;
P<0.01). During the 1-year QI process, the median DTN time decreased by 15% (from
65min in the first trimester to 55min in the last trimester;
P</=0.04) with a
non-significant 1.5-fold increase in the proportion of treated patients with a
DTN time</=60min (from 41% to 62%; P=0.09). CONCLUSION: It is feasible to deliver
tPA to patients with AIS within 60min in a general hospital, using MRI as the
routine screening modality, making this QI process to reduce DTN time widely
applicable to other secondary general hospitals.
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Langue : ANGLAIS