Barriers To Timely Administration Of Thrombolytics In Acute Ischemic Stroke Patients

Stroke is a leading cause of long term disability in the United States. The therapeutic benefits of intravenous thrombolytics is time dependent in an acute ischemic stroke patient and is an important determinant of 90 day and one year functional outcomes. This study investigated areas in the stroke alert process of a community based primary stroke care center that resulted in the delay of administration of thrombolytics within 60 minutes of an acute ischemic stroke patient\u27s arrival to the emergency room. A retrospective descriptive design was utilized and chart reviews were done on 40 patients that received thrombolytics in the emergency room. Patient characteristics and time variables associated with the various steps in the stroke alert process were extracted. Findings showed that only 7.5% of the patients received thrombolytics within the recommended 60 minutes, with the longest time interval associated with time from arrival to the emergency room to time of evaluation by teleneurologist. There were no significant differences in the characteristics of patients who received thrombolytics within 60 minutes and those patients that received thrombolytics after 60 minutes. Recommendations were made for changes in organizational and practice strategies to improve timely administration, and for future research involving the effects of quality improvement initiative