| Improving Door-to-Needle Times in Acute Ischemic Stroke: The Design and Rationale for the American Heart Association/American Stroke Association's Target: Stroke Initiative. | |
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MedLine Citation:
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PMID: 21885841 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND AND PURPOSE: The benefits of intravenous tissue-type plasminogen activator (tPA) in acute ischemic stroke are time-dependent, and guidelines recommend a door-to-needle time of ≤60 minutes. However, fewer than one third of acute ischemic stroke patients who receive tPA are treated within guideline-recommended door-to-needle times. This article describes the design and rationale of Target: Stroke, a national initiative organized by the American Heart Association/American Stroke Association in partnership with other organizations to assist hospitals in increasing the proportion of tPA-treated patients who achieve guideline-recommended door-to-needle times. METHODS: The initial program goal is to achieve a door-to-needle time ≤60 minutes for at least 50% of acute ischemic stroke patients. Key best practice strategies previously associated with achieving faster door-to-needle times in acute ischemic stroke were identified. RESULTS: The 10 key strategies chosen by Target: Stroke include emergency medical service prenotification, activating the stroke team with a single call, rapid acquisition and interpretation of brain imaging, use of specific protocols and tools, premixing tPA, a team-based approach, and rapid data feedback. The program includes many approaches intended to promote hospital participation, implement effective strategies, share best practices, foster collaboration, and achieve stated goals. A detailed program evaluation is also included. In the first year, Target: Stroke has enrolled over 1200 United States hospitals. CONCLUSIONS: Target: Stroke, a multidimensional initiative to improve the timeliness of tPA administration, aims to elevate clinical performance in the care of acute ischemic stroke, facilitate the more rapid integration of evidence into clinical practice, and improve outcomes. |
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Authors:
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Gregg C Fonarow; Eric E Smith; Jeffrey L Saver; Mathew J Reeves; Adrian F Hernandez; Eric D Peterson; Ralph L Sacco; Lee H Schwamm |
Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-9-1 |
Journal Detail:
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Title: Stroke; a journal of cerebral circulation Volume: - ISSN: 1524-4628 ISO Abbreviation: - Publication Date: 2011 Sep |
Date Detail:
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Created Date: 2011-9-2 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0235266 Medline TA: Stroke Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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From the Division of Cardiology, University of California, Los Angeles CA; Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Department of Neurology, University of California, Los Angeles, CA; Department of Epidemiology, Michigan State University, East Lansing, MI; Duke Clinical Research Center, Durham, NC; Miller School of Medicine, University of Miami, Miami, FL; Department of Neurology, Massachusetts General Hospital, Boston, MA. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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