Significant Improvement in Door-to-Needle Times and Clinical Outcomes with “Target: Stroke”

Anthony S. Kim, MD, MAS

The goal of treating at least 50% of eligible patients in 60 minutes or less was achieved in less than 4 years.

Earlier administration of intravenous thrombolysis for acute ischemic stroke is associated with improved outcomes. Yet, despite nearly two decades of practical experience developing systems of care to rapidly deliver tissue plasminogen activator (TPA), in-hospital delays are still common. To address this challenge, the American Heart Association/American Stroke Association and partner organizations launched the “Target: Stroke” quality improvement initiative in 2010 among hospitals that were participating in the Get With The Guidelines–Stroke registry. The stated goal was to enable participating hospitals to treat at least 50% of eligible patients with TPA within 60 minutes of hospital arrival through the use of a multimodal implementation tool kit and education program that incorporated 10 key evidence-based strategies for improvement and an annual recognition program for high-performing hospitals.

To evaluate the efficacy of this initiative, researchers analyzed data from 71,169 patients treated with TPA at 1030 hospitals. Median door-to-needle times improved from 77 minutes in the preintervention period to 67 minutes in the postintervention period. By the end of the post-intervention period, 53.3% of patients received TPA in 60 minutes or less. In-hospital mortality (9.9% to 8.3%), symptomatic intracranial hemorrhage rates (5.7% to 4.7%), and the percentage of patients discharged to home (38% to 43%) also improved.

Citation(s):

Fonarow GC et al. Door-to-needle times for tissue plasminogen activator administration and clinical outcomes in acute ischemic stroke before and after a quality improvement initiative. JAMA 2014 Apr 23; 311:1632.