Page 116

Karger_ESC London_2013

22. European Stroke Conference 18 Acute stroke: emergency management, stroke units and complications B 11:50 - 12:00 Reducing Thrombolysis Call to Needle Times – Preliminary Results from the Stroke90 Project J.M. Kendall1, D. Dutta2, E.A.M. Brown3, S.E. Caine4, R. Whiting5, R. Bosnell6, L.J. Shaw7, T. Black8, K.A. Rashed9, K.S. Aujla10, A. Mann11, D. Partlow12, P.J. Murphy13, S. Berry14 And on behalf of all teams participating in the AGWS Network Stroke90 Project North Bristol NHS Trust, Bristol, UNITED KINGDOM1,Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UNITED KINGDOM2, Avon Gloucestershire Wiltshire and Som-erset Cardiac and Stroke Network, Bristol, UNITED KINGDOM3, University Hospitals Bristol NHS Foundation Trust, Bristol, UNITED KINGDOM4, Taunton and Somerset NHS Founda-tion Trust, Taunton, UNITED KINGDOM5, North Bristol NHS Trust, Bristol, UNITED KING-DOM6, Royal United Hospital Bath NHS Trust, Bath, UNITED KINGDOM7, Salisbury NHS Foundation Trust, Salisbury, UNITED KINGDOM8, Yeovil District Hospital NHS Foundation Trust, Yeovil, UNITED KINGDOM9, Great Western Hospitals NHS Foundation Trust, Swindon, UNITED KINGDOM10, Great West-ern Ambulance Service NHS Trust, Chippenham, UNITED KINGDOM11, South Western Am-bulance Service NHS Foundation Trust, Exeter, UNITED KINGDOM12, University Hospitals Bristol NHS Foundation Trust, Bristol, UNITED KINGDOM13, Avon Gloucestershire Wiltshire and Somerset Cardiac and Stroke Network, Bristol, UNITED KINGDOM14 Background: Reducing thrombolysis call to needle times is a high priority for stroke services to improve outcomes. The AGWS Cardiac and Stroke Network in England set up the Stroke90 Project, which includes 8 hospitals and 2 ambulance services, in May 2012 to influence the whole thrombolysis pathway and set an expectation that patients would receive thrombolysis within 90 minutes of call for help. Along with other changes and increased training, a ‘Direct to CT’ policy was introduced to enable ambulance paramedics to transport potential thrombolysis patients directly to the CT scanner to be met en route by stroke teams to hasten the process of assessment and treatment. Methods: Baseline data were available for the period immediately before project launch (con-trols; n=100). A sample size calculation showed that data for 91 patients would be needed to detect a difference of 5 minutes with a significance level of 0.05 and power of 0.80. Data are available for patients thrombolysed from September to November 2012 after project launch (cases; n=125). Data are presented as medians and the Wilcoxon rank sum and chi- square tests used for analysis. Results: Median NIHSS was 12 for controls and 11 for cases (p=0.814). The proportion throm-bolysed out of hours was 60% vs. 46.4% (p=0.042). The following were the median time inter-vals (in minutes) for controls and cases; call to hospital time 55 vs. 57 min (p= 0.796), door to CT time 28 vs. 21 min (p=0.019), CT to needle time 38.5 vs. 30 min (p= 0.003), door to needle time 75 vs. 56 min (p<0.001) and onset to needle time 160.5 vs. 130 min (p=0.006). Call to needle time was 131 vs. 103.5 min (p <0.001). Conclusion: The Stroke90 Project is beginning to have a significant effect in reducing call to needle times via modification of the entire thrombolysis pathway, although there was a differ-ence in the proportion thrombolysed out of hours. Implementation of the project continues and further results will be available in due course. 17 Acute stroke: emergency management, stroke units and complications B 11:40 - 11:50 Rapid reductions in door-to-needle times through implementation of the Helsinki model for reduced stroke thrombolysis delays at the Royal Melbourne Hospital. A. Meretoja1, L. Weir2, M. Ugalde3, N. Yassi4, B. Yan5, P. Hand6, M. Truesdale7, S.M. Davis8, B.C.V. Campbell9 The Royal Melbourne Hospital, Parkville, AUSTRALIA1,The Royal Melbourne Hospital, Parkville, AUSTRALIA2, The Royal Melbourne Hospital, Parkville, AUSTRALIA3, The Royal Melbourne Hospital, Parkville, AUSTRALIA4, The Royal Melbourne Hospital, Parkville, AUS-TRALIA5, The Royal Melbourne Hospital, Parkville, AUSTRALIA6, The Royal Melbourne Hospital, Parkville, AUSTRALIA7, The Royal Melbourne Hospital, Parkville, AUSTRALIA8, The Royal Melbourne Hospital, Parkville, AUSTRALIA9 BACKGROUND Although intravenous thrombolytic therapy (tPA) for stroke is more effective when delivered early after symptom onset, in-hospital delays of >60 minutes are common. The Helsinki model of thrombolysis with a median 20 minutes door-to-needle time (DNT) was initially described at the 2012 European Stroke Conference, but has not been tested in other healthcare settings. METHODS The existing “code stroke” model at the Royal Melbourne Hospital was evaluated and restruc-tured in early 2012 to include key components of the Helsinki model: 1) Ambulance pre-noti-fication with patient details alerting the stroke team to meet the patient in the ED foyer; 2) Pa-tients transferred directly from triage onto the CT table on the ambulance stretcher and; 3) tPA delivered on the CT table immediately after imaging. We analysed our prospective consecutive tPA registry for effects of these protocol changes on our DNT following implementation during business hours (8am-5pm Mon-Fri) from May 2012. RESULTS There were 48 patients treated with tPA in the 8 months following the protocol change. Com-pared to 85 patients treated in 2011, the median (IQR) DNT was reduced from 61 (43-75) min-utes to 46 (24-79) mins (p=0.040). All of the effect came from the change in the in-hours DNT, down from 43 (33-59) to 25 (19-48) mins (p=0.009), whilst the out-of-hours delays remain un-changed, 67 (55-82) to 62 (44-95) mins (p=0.835). CONCLUSIONS We demonstrated rapid transferability of an optimized tPA protocol across different healthcare systems. With ambulance, ED, and stroke teams cooperating we succeeded in the absence of a dedicated neurological emergency department or electronic patient records featured in the Finn-ish system. The key components of pre-notification and direct-to-CT transfer produce the bulk of the results. Workforce issues have limited providing the same service level 24/7 although pre-notification has now been extended to out-of-hours and telemedicine may offer future bene-fits. 116 © 2013 S. Karger AG, Basel Scientific Programme


Karger_ESC London_2013
To see the actual publication please follow the link above