Emergency Medicine Pharmacist Impact on Door-to-Needle Time in Patients With Acute Ischemic Stroke

Lazy, lazy, lazy. I expect tPA administration in negative time, prior to the hospital. It can be done, you fucking lazy idiots don't read research and can't be bothered to do anything outside the status quo.  Many ways to get there, mainly by removing the neurologist and going straight to objective diagnosis.  Anything delivered in the hospital is too late, tPA delivery only fully works 12% of the time.  
I got tPA in 90 minutes, still too late to fully recover.  But it saved my life so I can be a pain in the ass to the complete failures in the stroke medical world. 
But are these other fast stroke diagnosis tools good enough to roll out to the world? Do you even know about them?

Hats off to Helmet of Hope - stroke diagnosis in 30 seconds

 

Microwave Imaging for Brain Stroke Detection and Monitoring using High Performance Computing in 94 seconds

 

New Device Quickly Assesses Brain Bleeding in Head Injuries - 5-10 minutes

 Maybe these 17 diagnosis possibilities to find out which one is the best? Or maybe the Qualcomm Xprize for the tricorder?

But the implied excuses follow in this research about why it is so goddamned hard to get tPA delivered fast.  My managers never allowed excuses, you solved the problem or else.

Emergency Medicine Pharmacist Impact on Door-to-Needle Time in Patients With Acute Ischemic Stroke

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Joshua S. Jacoby, PharmD, BCPS, Heather M. Draper, PharmD, BCPS, Lisa E. Dumkow, PharmD, BCPS, ...

First Published September 14, 2017 Research Article

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Abstract

Background and Purpose:

Decreased door-to-needle (DTN) time with tissue plasminogen activator (tPA) for acute ischemic stroke is associated with improved patient outcomes. Emergency medicine pharmacists (EMPs) can expedite the administration of tPA by assessing patients for contraindications, preparing, and administering tPA. The purpose of this study was to determine the impact of EMPs on DTN times and clinical outcomes in patients with acute ischemic stroke who receive tPA in the emergency department.

Methods:

A retrospective, single-center, cohort study of patients who received tPA between August 1, 2012, and August 30, 2014, was conducted to compare DTN times with or without EMP involvement in stroke care. Secondary outcomes included changes in neurological status as measured by the National Institutes of Health Stroke Scale (NIHSS), length of hospital stay, discharge disposition, symptomatic intracranial hemorrhage, and in-hospital all-cause mortality.

Results:

A total of 100 patients were included. The EMPs were involved in the care of 49 patients. The EMP involvement was associated with a significant improvement in DTN time (median 46 [interquartile range IQR: 34.5-67] vs 58 [IQR: 45-79] minutes; P = .019) and with receiving tPA within 45 minutes of arrival (49% vs 25%, odds ratio [OR]: 2.81 [95% confidence interval [CI]: 1.21-6.52]). National Institutes of Health Stroke Scale scores were significantly improved at 24 hours post-tPA in favor of the EMP group (median NIHSS 1 [IQR: 0-4] vs 2 [IQR: 1-9.25]; P = .047).

Conclusions:

The EMP involvement in initial stroke care was associated with a significant improvement in DTN time. (You assholes don't talk results, are your results that bad that you have to use bad goals to look good?)