Novel Telestroke Program Improves Thrombolysis for Acute Stroke Across 21 Hospitals of an Integrated Healthcare System

• DOI: 10.1161/strokeaha.117.018413
• Publication Date: 2017-12-15T10:05:25Z
• Authors: Mai N. Nguyen-Huynh; Jeffrey G. Klingman; Andrew L. Avins; Vivek A. Rao; Abigail Eaton; Sunil Bhopale; Anne C. Kim; John W. Morehouse; Alexander C. Flint
• Keywords: Expediting; Stroke; Acute stroke; Fibrinolytic agent

Faster treatment with intravenous alteplase in acute ischemic stroke is associated better outcomes. Starting 2015, Kaiser Permanente Northern California redesigned its workflow across all 21 centers to (1) follow a single standardized version of modified Helsinki model and (2) have emergency cases managed by dedicated telestroke neurologist. We examined the effect California's Stroke EXpediting PRrocess Evaluating Stopping program on door-to-needle (DTN) time, use, symptomatic intracranial hemorrhage rates.The was introduced staggered fashion from September 2015 January 2016. compared DTN times for seasonally adjusted 9-month period at each center before implementation corresponding calendar start implementation. The primary outcome time administration. Secondary outcomes included rate administrations per month, hemorrhage, disposition discharge.This study 310 patients treated pre-EXpediting 557 period. After implementation, increased 62/mo 34/mo baseline (P<0.001). Median decreased 34 minutes after 53.5 prior (P<0.001), <60 achieved 87.1% versus 61.0% (P<0.001) patients. <30 were much more common (40.8% 4.2% implementation). There no significant difference rates 2 periods (3.8% 2.2% implementation; P=0.29).Introduction protocol hospitals using management administrations, significantly shorter times, increase adverse