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IMPACT OF A STROKE PROTOCOL ON THE DOOR-TO-NEEDLE TIME: A FEASIBILITY STUDY

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IMPACT OF A STROKE PROTOCOL ON THE DOOR-TO-NEEDLE TIME: A FEASIBILITY STUDY J. Vanhoucke1, D. Hemelsoet2, E. Achten3, S. Hachimi-Idrissi1. 1Ghent University Hospital, Department of Emergency Medicine, Gent, Belgium. 2Ghent University Hospital, Department of Neurology, Gent, Belgium. 3Ghent University Hospital, Department of Radiology, Gent, Belgium. Background and Aims Thrombolysis within 4,5 hours of ischemic stroke onset can improve outcome. Guidelines recommend administration of thrombolytics within 60 minutes upon arrival at the hospital, meaning door-to-needle time (DNT) should be less than 60 minutes. The earlier the treatment is started, the greater the benefits. In this study, a stroke protocol was introduced at the emergency department of the Ghent University Hospital with as primary goal to shorten the DNT. Method This study was an uncontrolled before-after study. A stroke protocol, consisting of multiple interventions, was implemented and the results from the pre-stroke protocol period (Pre-SP period, from August 15th 2016 until March 5th 2017) were compared to the results of the post-stroke protocol period (Post-SP period, from March 6th 2017 until July 16th 2017). Results The median DNT decreased significantly from 57 minutes in the Pre-SP period to 33 minutes in the Post-SP period (P < 0,001). When analyzing all patients included in the study and adjusting the results for other variables that might have an influence on these time intervals, the triage-to-emergency physician time (TET), emergency physician-to-CT time (ECT) and CT-to-needle time (CNT) also decreased significantly. When we analyzed these time intervals for only those who received thrombolysis, the TET and CNT decreased significantly. There was a statistically significant effect of the implementation of the stroke protocol on the number of patients treated with a DNT within 20, 30, 45 and 60 minutes (P = 0.008). Conclusion A significant decrease in DNT can be achieved by implementing this stroke protocol.

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