[S02.007] A Simple, Real-Time Text-Messaging Intervention Is Associated with Improvements Door-to-Needle Times for Acute Ischemic Stroke
Molly Burnett, San Francisco, CA, Lara Zimmermann, San Francisco, CA, Zlatan Coralic, San Francisco, CA, Tina Quon, San Francisco, CA, William Whetstone, San Francisco, CA, Anthony Kim, San Francisco, CA
OBJECTIVE: To evaluate a simple, real-time text-messaging intervention designed to improve door-to-needle (DTN) times for acute ischemic stroke patients. BACKGROUND: Although earlier administration of intravenous tissue plasminogen activator (IV tPA) is associated with increased efficacy, developing robust hospital processes to ensure prompt treatment remains a challenge. DESIGN/METHODS: We reviewed DTN times for consecutive adults with acute ischemic stroke treated with IV tPA at a tertiary academic center ED in the 40 months before and 15 months after a quality improvement intervention was rolled out (April 2011). Code Stroke teams are led by on-call neurology residents. By protocol, a multimodal CT/CTA/CTP is completed before IV tPA. The intervention consisted of 1) a requirement for the on-call neurology resident to report the DTN time for each Code Stroke activation to the entire multidisciplinary team by text page in real-time; 2) a review of DTN performance by the Stroke Center Director the next day; and 3) a biweekly dashboard of DTN performance. DTN times were abstracted from comprehensive medical records. Time series data were first evaluated for secular trends by visual inspection and linear regression. The rank sum test was used to compare median DTN time. Fisher's exact test was used for univariate associations. RESULTS: A total of 141 patients (mean age 73 y, 54% women, median NIHSS 10 [IQR 4-17]) received IV tPA (95 pre- and 46 post-intervention). Age and NIHSS were comparable in the two groups and there was no significant secular trend (slope = -0.2 min/month, p=0.48). Median DTN time was significantly lower with the intervention (65 min [IQR 52-71] vs. 86 min [IQR 68-103], rank sum p<0.0001) and a significantly higher proportion of patients were treated within 60 minutes (50% vs. 16%, p<0.001). CONCLUSIONS: A simple real-time text-messaging intervention was associated with significant improvement in DTN times.
Category - Cerebrovascular Disease: Acute Stroke Therapy
Tuesday, March 19, 2013 2:30 PM
Session S02: Acute Stroke Therapy (1:00 PM-2:45 PM)