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

The tyranny of low expectations raises its ugly head once again. Talking about door to needle time rather than negative time, treatment in the ambulance. Quite possible to get there with these diagnosis tools.

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

 

Noninvasive Cerebral Oximetry May Help Detect LAO Stroke - 1-2 minutes

FDA approves a visor to detect strokes - Cerebrotech, 30 seconds

  If your hospital does not know of them they are completely fucking incompetent.
http://journals.sagepub.com/doi/abs/10.1177/1941874417729982

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Joshua S. Jacoby, PharmD, BCPS¹

Joshua S. Jacoby

1Department of Pharmacy, Mercy Health Saint Mary’s Campus, Grand Rapids, MI, USA
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, Heather M. Draper, PharmD, BCPS¹

Heather M. Draper

1Department of Pharmacy, Mercy Health Saint Mary’s Campus, Grand Rapids, MI, USA
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, Lisa E. Dumkow, PharmD, BCPS¹

Lisa E. Dumkow

1Department of Pharmacy, Mercy Health Saint Mary’s Campus, Grand Rapids, MI, USA
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Muhammad U. Farooq, MD²

Muhammad U. Farooq

2Department of Neurology, Mercy Health Physician Partners, Grand Rapids, MI, USA
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, G. Robert DeYoung, PharmD, BCPS¹

G. Robert DeYoung

1Department of Pharmacy, Mercy Health Saint Mary’s Campus, Grand Rapids, MI, USA
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, Kasey L. Brandt, PharmD, BCPS¹

Kasey L. Brandt

1Department of Pharmacy, Mercy Health Saint Mary’s Campus, Grand Rapids, MI, USA
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First Published September 14, 2017 Research Article

https://doi.org/10.1177/1941874417729982

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Article Information

Volume: 8 issue: 2, page(s): 60-65

Article first published online: September 14, 2017; Issue published: April 1, 2018

https://doi.org/10.1177/1941874417729982

Joshua S. Jacoby, PharmD, BCPS¹, Heather M. Draper, PharmD, BCPS¹, Lisa E. Dumkow, PharmD, BCPS¹, Muhammad U. Farooq, MD², G. Robert DeYoung, PharmD, BCPS¹, Kasey L. Brandt, PharmD, BCPS¹

¹Department of Pharmacy, Mercy Health Saint Mary’s Campus, Grand Rapids, MI, USA

²Department of Neurology, Mercy Health Physician Partners, Grand Rapids, MI, USA

Corresponding Author: Joshua S. Jacoby, Department of Pharmacy, Mercy Health Saint Mary’s Campus, 200 Jefferson Ave SE, Grand Rapids, MI 49503, USA. Email: joshua.jacoby@mercyhealth.com

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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.