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SIX MINUTES SAVED FROM DOOR-TO-NEEDLE TIME FOR STROKE THROMBOLYSIS ENSUING FROM A CHANGE OF INFORMED CONSENT POLICY IN SINGAPORE

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ESOC-2019

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Abstract

Obtaining written consent has been identified as a potential delay in stroke thrombolysis. In 2016, Singapore introduced policy change to encourage stroke centers to adopt practice of using verbal rather than written consent. We report the effect of policy change in reducing door-to-needle (DTN) time. Using Singapore Stroke Registry, we analysed data of 338 acute ischemic stroke patients who received thrombolysis between January 2015 and December 2016 from two participating hospitals that changed practice from written to verbal consent. There were no other policy changes during this period. Multivariate regression models with generalized estimating equations were used to evaluate association between consent policy changes and DTN times while adjusting for patients’ baseline characteristics and within-hospital clustering. Patient demographics, stroke severity, presentation during versus after office hours, or arrival via emergency medical services, were similar between 137 patients in the pre-intervention group and 201 patients in the post-intervention group. Median DTN time decreased from 67 minutes (IQR 54-86) to 57 minutes (IQR 43-71) following the use of verbal consent. After risk adjustment, this policy change was associated with 6.7 minutes reduction (95% CI, 0.6-12.7) in DTN time. The percentage of patients with DTN <60 and DTN<45 increased by twofold (36.8% to 59.1%; OR 2.13; 95% CI, 1.27-3.58) and threefold (10.5% to 31.4%; OR 3.22; 95% CI, 1.52-6.81) respectively. This is the first study to show that timeliness of thrombolysis improved with the change from written to verbal consent, providing direct evidence for this strategy.

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