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A Qualitative Assessment of Practices Associated With Shorter Door-to-Needle Time for Thrombolytic Therapy in Acute Ischemic Stroke

Olson, DaiWai M.; Constable, Mark; Britz, Gavin W.; Lin, Cheryl B.; Zimmer, Louise O.; Schwamm, Lee H.; Fonarow, Gregg C.; Peterson, Eric D.

Journal of Neuroscience Nursing: December 2011 - Volume 43 - Issue 6 - p 329–336
doi: 10.1097/JNN.0b013e318234e7fb
Article

ABSTRACT Early treatment with intravenous (IV) recombinant tissue plasminogen activator/alteplase (tPA) is associated with improved outcomes for patients with an acute ischemic stroke. Thus, rapid triage and treatment of stroke patients are essential, with a goal of door-to-needle time of no more than 60 minutes. We sought to identify best practices associated with faster treatment among hospitals participating in Get With the Guidelines—Stroke. Qualitative telephone interviews were conducted to elicit strategies being used by these centers to assess, treat, and monitor stroke patients treated with IV tPA. We sequentially carried out these interviews until we no longer identified novel factors. Interviews were conducted with 13 personnel at 7 top-performing U.S. hospitals. With the use of a hermeneutic–phenomenological framework, 5 distinct domains associated with rapid IV tPA delivery were identified. These included (a) communication and teamwork, (b) process, (c) organizational culture, (d) performance monitoring and feedback, and (e) overcoming barriers.

Questions or comments about this article may be directed to DaiWai M. Olson, PhD RN, at Olson006@mc.duke.edu. He is an assistant professor in the Department of Neurology at Duke University Medical Center, Durham, NC.

Mark Constable, RN, is a stroke coordinator at Duke University Medical Center, Durham, NC.

Gavin W. Britz, MD, is a neurosurgeon in the Department of Neurology at Duke University Medical Center, Durham, NC.

Cheryl B. Lin, BS, is a medical student at Duke Clinical Research Institute, Durham, NC.

Louise O. Zimmer, MPH, is a project manager at Duke Clinical Research Institute, Durham, NC.

Lee H. Schwamm, MD, is a professor of neurology in the Department of Neurology at Massachusetts General Hospital, Boston, MA.

Gregg C. Fonarow, MD, is a professor of cardiovascular medicine in the Division of Cardiology at the University of California, Los Angeles, CA.

Eric D. Peterson, MD, is a professor of medicine at Duke Clinical Research Institute, Durham, NC.

This project was supported by cooperative agreement number U18HS016964 from the Agency for Healthcare Research and Quality.

The authors declare no conflicts of interest.

© 2011 American Association of Neuroscience Nurses