A Brain Attack Protocol Achieving Better Door to Needle Time in Stroke (P2.304)

Abstract

Objective: To evaluate the impact of a newly implemented Brain Attack (BrA) protocol in our institution as a quality improvement project. Background: Rapid administration of intravenous thrombolysis in patients with acute ischemic stroke requires a well-coordinated process. American Heart Association reduced the door to needle time from 60 to 45 minutes(min) to achieve better clinical outcome. Methods: Single center retrospective chart review of our brain attack database before and after the newly implemented brain attack protocol on April 2014 at the Cleveland Clinic Florida. The major difference in the BrA protocol was the performance of head computed tomography (CT) scanning before neurological assessment as compared to after. We assessed demographic data, and the times for door to neurology assessment, door to CT imaging and interpretation and door to needle from 06/2013 through 04/2014 (Pre-BrA group) as compared to 06/2014 through 04/2015 (Post-BrA group). Results: A total of 199 patients (76 in the Pre-BrA group and 123 in the Post-BrA group) were included in this study. Both groups were similarly comparable in age, sex and risk factors. NIHSS results on admission were also comparable among both groups (mean 4.8 in the Pre-BrA group and 6.7 in the Post-BrA group). After the new brain attack protocol was formally established the door to neurology assessment time was reduced from a mean of 15 to 5 min. There was a reduction in door to CT time from a mean of 14.9 to 4.1 min and door to imaging interpretation from 36.9 to 19.5 min. For patients eligible for thrombolysis (15 in the Pre-BrA group and 23 in the Post-BrA group) the door to needle time was reduced from a mean of 53 to 40 min. Conclusion: The newly implemented brain attack protocol in our institution was successful in reducing door to needle time.

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