http://nho.sagepub.com/content/2/4/119.full
Introduction
Patients with ischemic stroke benefit from intravenous tissue plasminogen activator (tPA), when given expeditiously.1
Current best practice strategy identified by American Heart
Association/American Stroke Association (AHA/ASA) sponsored Target:
Stroke program is to achieve a door-to-needle time
(DNT) ≤60 minutes for at least 50% of patients with acute ischemic
stroke.
However, less than one third of patients with acute
ischemic stroke who receive tPA are treated within the
guideline-recommended
60 minutes.2
This program has identified 10 key strategies to improve DNT. These
include emergency medical service prenotification, activating
the stroke team with a single call, rapid
acquisition and interpretation of brain imaging, use of specific
protocols and tools,
premixing tPA, a team-based approach, and rapid
data feedback.(I bet my 11 ways would be faster and easier) Neurohospitalists are inpatient site-specific specialists
mainly
responsible for managing inpatient neurological
conditions.3
Community neurologists, who are chiefly outpatient based and
periodically cover the hospital on call, may not have time or
interest to focus on inpatient quality and safety
metrics on top giving optimal care to their outpatient population.
Neurohospitalist
model has been associated with reduced length of
stay in patients with ischemic stroke.4
Limited data are available regarding whether inpatient neurohospitalist
evaluation has an impact on DNT for intravenous thrombolysis
in patients with ischemic stroke within 4.5 hours
of symptom onset. We know that most inpatient neurologists are vascular
neurologists.2
But, there is no specific data comparing vascular neurologists and
community neurologists on the quality of inpatient care.
Our aim is to retrospectively compare DNT for
intravenous thrombolysis in ischemic stroke between nonneurohospitalists
and
neurohospitalists at a single institution in the
emergency department (ED).
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