Reducing the Door-to-needle Interval, Experience from the Stroke Centre in Kladno

Czech version

Authors: M. Šrámek ^1,2; T. Růžičková ^2,3; P. Kešnerová ^2,3; P. Kadlecová ⁴; R. Mikulík ^4,5
Authors‘ workplace: Neurologické oddělení, Nemocnice Hořovice ¹; Neurologická klinika 2. LF UK a FN v Motole, Praha ²; Neurologické oddělení, Oblastní nemocnice Kladno, a. s. ³; Neurologická klinika LF MU a FN u sv. Anny v Brně ⁴; Mezinárodní centrum klinického výzkumu (ICRC), FN u sv. Anny v Brně v Brně ⁵
Published in: Cesk Slov Neurol N 2014; 77/110(6): 747-752
Category: Short Communication

R. Mikulík a P. Kadlecová jsou podporováni z Evropského fondu regionálního rozvoje – Projekt FNUSA-ICRC (No. CZ.1.05/1.1.00/02.0123).

Overview

Aim:
To analyze the effectiveness of interventions intended to reduce door-to-needle time (DNT) for patients treated with intravenous thrombolysis (IVT), considering that DNT is the only parameter we can influence to improve the efficacy of IVT.

Material and methods:
The data were collected from the Stroke Centre of the Kladno Regional Hospital over the period 07/ 2011 to 06/ 2013. Interventions intended to reduce the DNT have been implemented in 05/ 2012 and include: well-developed cooperation with the emergency medical service, improved coordination of care within the hospital, administration of IVT immediately after CT in selected patients. DNTs in the target group (patients treated after implementation of the interventions) were compared to the DNTs in a historical control group (patients treated with thrombolysis from 7/ 2011 to 4/ 2012). Multiple logistic regression analysis was used for adjusting the baseline characteristics of the patients.

Results:
The target group showed clinically crucial shortening of DNT from 65 min to 45 min (p = 0.001), a slight reduction of the median onset-to-treatment time (OTT) from 144 min to 130 min (p = 0.66) and a slight decrease in symptomatic intracranial hemorrhage (SICH) compared to the control group – from 4.40% to 3.70% (OR 0.90, 95% CI: 0.11– 7.03). We did not detect any SICH in the group of patients who were treated even though the complete laboratory results were not known (n = 17). Patients treated during working hours had a 6.8– times higher chance of treatment initiation within 60 min compared to patients treated during “on call” hours (OR 6.78, 95% CI: 2.34– 19.64).

Conclusions:
The interventions implemented to reduce DNT were highly effective and safe. IVT administration without complete laboratory results in selected patients was safe and significantly contributed to reducing the median DNT of the entire group.

Key words:
stroke – reducing DTN – increasing efficacy of IVT

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

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