Xian Ying, Xu Haolin, Lytle Barbara, Blevins Jason, Peterson Eric D, Hernandez Adrian F, Smith Eric E, Saver Jeffrey L, Messé Steven R, Paulsen Mary, Suter Robert E, Reeves Mathew J, Jauch Edward C, Schwamm Lee H, Fonarow Gregg C
From the Duke Clinical Research Institute, Durham, NC (Y.X., H.X., B.L., J.B., E.D.P., A.F.H.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); Department of Neurology (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; University of Pennsylvania, Philadelphia (S.R.M.); American Heart Association, Dallas, TX (M.P.); Department of Emergency Medicine, University of Texas Southwestern, Dallas, TX (R.E.S.); Michigan State University, East Lansing (M.J.R.); Medical University of South Carolina, Charleston (E.C.J.); and Stroke Service, Massachusetts General Hospital, Boston (L.H.S.).
Circ Cardiovasc Qual Outcomes. 2017 Jan;10(1). doi: 10.1161/CIRCOUTCOMES.116.003227.
The implementation of Target: Stroke Phase I, the first stage of the American Heart Association's national quality improvement initiative to accelerate door-to-needle (DTN) times, was associated with an average 15-minute reduction in DTN times.
Stroke phase II was launched in April 2014 with a goal of promoting further reduction in treatment times for tissue-type plasminogen activator (tPA) administration.
We conducted a second survey of Get With The Guidelines-Stroke hospitals regarding strategies used to reduce delays after Target: Stroke and quantify their association with DTN times. A total of 16 901 ischemic stroke patients were treated with intravenous tPA within 4.5 hours of symptom onset from 888 surveyed hospitals between June 2014 and April 2015. The patient-level median DTN time was 56 minutes (interquartile range, 42-75), with 59.3% of patients receiving intravenous tPA within 60 minutes and 30.4% within 45 minutes after hospital arrival. Most hospitals reported routinely using a majority of Target: Stroke key practice strategies, although direct transport of patients to computed tomographic/magenetic resonance imaging scanner, premix of tPA ahead of time, initiation of tPA in brain imaging suite, and prompt data feedback to emergency medical services providers were used less frequently. Overall, we identified 16 strategies associated with significant reductions in DTN times. Combined, a total of 20 minutes (95% confidence intervals 15-25 minutes) could be saved if all strategies were implemented.
Get With The Guidelines-Stroke hospitals have initiated a majority of Target: Stroke-recommended strategies to reduce DTN times in acute ischemic stroke. Nevertheless, certain strategies were infrequently practiced and represent a potential immediate target for further improvements.
美国心脏协会全国质量改进倡议的第一阶段“目标：卒中I期”的实施，使门到针（DTN）时间平均缩短了15分钟。“目标：卒中II期”于2014年4月启动，目标是进一步缩短组织型纤溶酶原激活剂（tPA）给药的治疗时间。
我们对“遵循指南：卒中”医院进行了第二次调查，内容涉及“目标：卒中”后用于减少延误的策略，并量化这些策略与DTN时间的关联。在2014年6月至2015年4月期间，对888家参与调查的医院中16901例症状发作4.5小时内接受静脉注射tPA治疗的缺血性卒中患者进行了研究。患者层面的DTN时间中位数为56分钟（四分位间距，42 - 75），59.3%的患者在入院后60分钟内接受静脉注射tPA，30.4%在45分钟内接受。大多数医院报告常规采用了大部分“目标：卒中”关键实践策略，不过将患者直接转运至计算机断层扫描/磁共振成像扫描仪、提前预混tPA、在脑成像室启动tPA以及及时向紧急医疗服务提供者反馈数据的使用频率较低。总体而言，我们确定了16种与DTN时间显著缩短相关的策略。如果实施所有策略，总共可节省20分钟（95%置信区间15 - 25分钟）。
“遵循指南：卒中”医院已启动了大部分“目标：卒中”推荐的策略来缩短急性缺血性卒中的DTN时间。然而，某些策略的实施频率较低，是进一步改进的潜在直接目标。
