Provincial Door-to-Needle Improvement Initiative Results in Improved Patient Outcomes Across an Entire Population.
Aged
Aged, 80 and over
Alberta
/ epidemiology
Brain Ischemia
/ drug therapy
Cohort Studies
Female
Humans
Male
Middle Aged
Patient Reported Outcome Measures
Population Surveillance
/ methods
Stroke
/ drug therapy
Thrombolytic Therapy
/ standards
Time-to-Treatment
/ standards
Tissue Plasminogen Activator
/ administration & dosage
brain ischemia
cohort studies
hospital mortality
humans
quality improvement
Journal
Stroke
ISSN: 1524-4628
Titre abrégé: Stroke
Pays: United States
ID NLM: 0235266
Informations de publication
Date de publication:
08 2020
08 2020
Historique:
pubmed:
10
7
2020
medline:
5
11
2020
entrez:
10
7
2020
Statut:
ppublish
Résumé
Improving door-to-needle times (DNTs) for thrombolysis of acute ischemic stroke patients improves outcomes, but participation in DNT improvement initiatives has been mostly limited to larger, academic medical centers with an existing interest in stroke quality improvement. It is not known whether quality improvement initiatives can improve DNT at a population level, including smaller community hospitals. This study aims to determine the effect of a provincial improvement collaborative intervention on improvement of DNT and patient outcomes. A pre post cohort study was conducted over 10 years in the Canadian province of Alberta with 17 designated stroke centers. All ischemic stroke patients who received thrombolysis in the Canadian province of Alberta were included in the study. The quality improvement intervention was an improvement collaborative that involved creation of interdisciplinary teams from each stroke center, participation in 3 workshops and closing celebration, site visits, webinars, and data audit and feedback. Two thousand four hundred eighty-eight ischemic stroke patients received thrombolysis in the pre- and postintervention periods (630 in the post period). The mean age was 71 years (SD, 14.6 years), and 46% were women. DNTs were reduced from a median of 70.0 minutes (interquartile range, 51-93) to 39.0 minutes (interquartile range, 27-58) for patients treated per guideline ( The improvement collaborative was likely the key contributing factor in reducing DNTs and improving outcomes for ischemic stroke patients across Alberta.
Sections du résumé
BACKGROUND AND PURPOSE
Improving door-to-needle times (DNTs) for thrombolysis of acute ischemic stroke patients improves outcomes, but participation in DNT improvement initiatives has been mostly limited to larger, academic medical centers with an existing interest in stroke quality improvement. It is not known whether quality improvement initiatives can improve DNT at a population level, including smaller community hospitals. This study aims to determine the effect of a provincial improvement collaborative intervention on improvement of DNT and patient outcomes.
METHODS
A pre post cohort study was conducted over 10 years in the Canadian province of Alberta with 17 designated stroke centers. All ischemic stroke patients who received thrombolysis in the Canadian province of Alberta were included in the study. The quality improvement intervention was an improvement collaborative that involved creation of interdisciplinary teams from each stroke center, participation in 3 workshops and closing celebration, site visits, webinars, and data audit and feedback.
RESULTS
Two thousand four hundred eighty-eight ischemic stroke patients received thrombolysis in the pre- and postintervention periods (630 in the post period). The mean age was 71 years (SD, 14.6 years), and 46% were women. DNTs were reduced from a median of 70.0 minutes (interquartile range, 51-93) to 39.0 minutes (interquartile range, 27-58) for patients treated per guideline (
CONCLUSIONS
The improvement collaborative was likely the key contributing factor in reducing DNTs and improving outcomes for ischemic stroke patients across Alberta.
Identifiants
pubmed: 32640947
doi: 10.1161/STROKEAHA.120.029734
doi:
Substances chimiques
Tissue Plasminogen Activator
EC 3.4.21.68
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2339-2346Investigateurs
Dana Allen
(D)
Bill Anderson
(B)
Joanne Angelstand
(J)
Emmanuel Anokye
(E)
Cherylyn Antymniuk
(C)
Natalie Arsenault
(N)
Brenda Ashman
(B)
Kathy Baker
(K)
Jackie Bakker
(J)
Darla Balenga
(D)
Melissa Berg
(M)
Lori-Ann Berry
(LA)
Michael Betzner
(M)
Lauren Black
(L)
Denise Blain
(D)
Tracy Boutilier
(T)
Joanne Brady
(J)
Stacey Lynn Brewster
(S)
Patricia Brown
(P)
Ken Buchynski
(K)
Erin Bugbee
(E)
Michael Bullard
(M)
Doug Burke
(D)
Chloe Burnett
(C)
Kenneth Butcher
(K)
Paula Cackett
(P)
Hal Canham
(H)
Ann Chiovetti
(A)
Lana Chivers
(L)
Caitlin Cobb
(C)
M C Cote
(MC)
Shelagh Coutts
(S)
Deb Currie
(D)
James Eric Daniels
(J)
Natasha Desouza
(N)
Mona Diebert
(M)
Tanya Dixon
(T)
Jennifer Dotchin
(J)
Sandy Duckett
(S)
Verlyne Dustow
(V)
Robyn Dwyer
(R)
Margaret Dymond
(M)
Cathy Edmond
(C)
Muneer Eesa
(M)
Nicole Elias
(N)
Tara Elliott
(T)
Simone Empson
(S)
Liz Falls
(L)
Mark Forder
(M)
Rhonda Foreman
(R)
Darrel Forsythe
(D)
Twyla Fortier
(T)
Laura Fowler
(L)
Shelly Franklin
(S)
Jim Garland
(J)
Catherine Garon
(C)
Darrin Gerl
(D)
Imran Ghauri
(I)
Sherry Gough
(S)
Kevin Govender Mark
(KG)
Gripp Mary-Lou Halabi
(G)
Sandy Halldorson
(S)
Jean Harsch
(J)
Caroline Hatcher
(C)
Kathryn Hebner
(K)
Richard Hemsley
(R)
Dawn Holloway
(D)
Denise Holman
(D)
Scott Holsworth
(S)
Stephanie Holton
(S)
Gavin Hull
(G)
Barb Hyciek
(B)
Richard Ibach
(R)
Oje Imoukhuede
(O)
Barbara Jeal
(B)
Denman Jill
(D)
Marie Johnson
(M)
Ozi Jones
(O)
Alison Kabaroff
(A)
Hayrapet Kalashyan
(H)
Frddy Kay
(F)
Pam Kaytor
(P)
Tim Keppy
(T)
Philo King
(P)
Sharon Kiszszak
(S)
Ryan Klick
(R)
Evelyn Koshurba
(E)
Rob Kruhlak
(R)
Julie Lacasse
(J)
Mike Lane
(M)
Tamara Laughs
(T)
Leslie Laut-Barss
(L)
Pam Lavalee
(P)
Tania Leclair
(T)
Paul Linden
(P)
Troy Linderman
(T)
Jason Livingstone
(J)
Marilyn Lodder
(M)
Karen Lundgard
(K)
Elaine Lyle
(E)
Kathleen Mackenzie
(K)
Ashleigh Malarczuk
(A)
Dave Malfair
(D)
Jamie Malone
(J)
Herbert Manosalva Alzate
(H)
Kerry McCann
(K)
Shannon McCarthy
(S)
Melissa McKenzie
(M)
Leta McRobert
(L)
Dana Meroniuk
(D)
Ryan Millar
(R)
Rob Miller
(R)
Bilan Mir
(B)
John Montpetit
(J)
Jackie Morissette
(J)
Laurel Morrison
(L)
Fiona Murray-Galbraith
(F)
Firdaus Mydeen
(F)
Lakshmi Namagiri
(L)
Nicole Neidig
(N)
Gordon Neil
(G)
Nancy Newcommon
(N)
Craig Newell
(C)
Chris Nichol
(C)
Colleen Norris
(C)
Dana Norton
(D)
Sara Noseworthy
(S)
Linda O'Hara
(L)
Shannon O'Neail
(S)
Wes Orr
(W)
Elysia Panes
(E)
Tita Panes
(T)
Joyce Paradis
(J)
Teresa Parry
(T)
Darlene Peacock
(D)
Thomas Peebles
(T)
Steen Petersen
(S)
Ian Phelps
(I)
Roy Pooley
(R)
Nicholas Potvin
(N)
Rosanne Pryor
(R)
Max Ramsahoye
(M)
Mohammad Rashead
(M)
Kevin Reedyk
(K)
Darla Reynolds
(D)
Steven Rideout
(S)
Kara Rimmer
(K)
Emad Salih
(E)
Patrick San Agustin
(P)
Darren Sandbeck
(D)
Salim Sattar
(S)
Natalie Sauter
(N)
Kim Schmidt
(K)
Elizabeth Seib
(E)
Jason Selzler
(J)
Bill Sevcik
(B)
Donna Sharman
(D)
Ashfaq Shuaib
(A)
Dawn Smith
(D)
Brent Snider
(B)
Jonathan Snider
(J)
Joe Stander
(J)
Caroline Stephenson
(C)
Candice Stewart
(C)
Carol Stoyberg
(C)
Yvonne Suranyi
(Y)
Myles Tablin
(M)
Colleen Taralson
(C)
Janice Throndson
(J)
Kristen Traverse
(K)
Dalique van der Nest
(D)
Tyler Van Mulligan
(T)
Cornelius Van Vuuren
(C)
Erich Vanderlinde
(E)
Renee Vilneff
(R)
Glenda Volk
(G)
Krystal Wall
(K)
De Juan Thur Wang
(JT)
Dave Warharft
(D)
Jaylene Watson
(J)
Lorraine Weir
(L)
Dale Weiss
(D)
Dave Welch
(D)
Toni Winder
(T)
Winona Winsor
(W)
Douglas Woudstra
(D)
Dana Youn
(D)
Leane Young
(L)
Charlotte Zerna
(C)