NEW YORK (Reuters Health) – Use of a regional learning collaborative model is associated with significantly reduced stroke-thrombolysis times, researchers report.
Time saved from acute ischemic stroke symptom onset to initiation of tissue-type plasminogen activator (tPA) is known to translate into better outcomes. Hence, the door-to-needle (DTN) time goal of <60 minutes established in the Brain Attack Coalition and other guidelines.
Dr. Shyam Prabhakaran from Northwestern University Feinberg School of Medicine in Chicago, Illinois and colleagues evaluated the impact of a regional learning collaborative among 15 primary stroke centers in Chicago area on reducing DTN times for stroke thrombolysis.
The learning collaborative model included five components: a quality improvement leader, a stroke content expert, multidisciplinary teams from each site, face-to-face collaboration, and a targeted goal (DTN time <60 minutes in >50% of patients treated with tPA).
The researchers compared results with those from 15 primary stroke centers in St. Louis, Missouri.
Within the first quarter after implementation of the learning collaborative model, the median DTN time decreased from 73 minutes (DTN time <60 minutes in 40.9% of patients) to 59 minutes (DTN time <60 minutes in 50.0%), the team reports online in Circulation: Cardiovascular Quality and Outcomes.
These improvements were maintained in subsequent quarters without further drops in DTN time. In a combined adjusted model, the decrease in median DTN per quarter was significantly greater in Chicago than in St. Louis (2.24 min vs. 1.60 min, p= 0.043).
DTN process strategies that were increasingly used after implementation included a direct-to-CT scanner protocol, premixing tPA, tPA before laboratory results, stroke code activation at triage, and a streamlined consent process.
“Compared with concurrent controls, we noted a 15-minute improvement within 1 quarter of implementation, which was sustained over the subsequent 2 years,” the researchers conclude. “We recommend the use of structured regional learning collaborative models for rapid and sustainable system-wide quality improvement in stroke care.”
Genentech funded the trial. Dr. Prabhakaran did not respond to a request for comments.