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Time is Brain
by Dr Rajinder Singh, Consultant, Department of Neurology
[Best Singhealth Clinical Practice Improvement Programme Award 2010]
Mission Statement
To increase the rate of achieving a door-to-needle time of less than 60 minutes for Acute Stroke patients receiving IV r-TPA at the NNI (TTSH campus)
Baseline Data Prior to Project Implementation
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In 2008, 13 patients received IV TPA
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Median symptom onset to door time was 60 minutes
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Median door-to-scan time was 35 minutes
Range: 15 to 120 minutes
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Median door-to-needle time was 75 minutes
Range: 30 to 135 minutes
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40% achieved the ideal door-to-needle time of less than 60 minutes
Post-Project Implementation 2009
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24 patients were thrombolysed in 2009 compared to 13 in 2008; this represents an increase of more than 84% (almost twice the number).
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Median door-to-needle time has decreased further to 50 minutes (range 25 to 80 minutes) from 55 minutes in mid-2009 (75 minutes pre-CPIP).
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Greater consistency in time has also been achieved.
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This represents a vast improvement from previous median door-to-needle time of 75 minutes – before implementation of this CPIP project.
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More than 83% of the patients treated in 2009 achieved the target door-to-needle time of < 60 minutes; hence meeting the CPIP projected target in the Mission Statement.
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Reinforcement of the protocol and workflow was done to the Neurology and ED team members and staff at regular time intervals to ensure optimal compliance.
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Overall, there has been greater awareness and vigilance for acute stroke treatment amongst staff as a result of this project.
Savings
Early treatment of Acute Ischemic Stroke with IV TPA has been shown to shorten hospital stay, lessen disability and improve functional outcomes. (This has been proven using Markov models)à resulting in overall healthcare cost savings.
Without Treatment, a typical large vessel stroke kills roughly 2 million neurons, 14 billion synapses & over 7 miles of myelinated fibres each minute.
IV rTPA quadruples the likelihood of minimal or no disability when a patient is treated 60 minutes into their symptoms rather than at 180 minutes.
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