Efforts to reduce the door-to-needle time of thrombolysis in acute ischemic stroke: video-assisted therapeutic risk communication.

BACKGROUND/PURPOSE:Explaining the risks and benefits of recombinant tissue-plasminogen activator (rtPA) to eligible patients with acute ischemic stroke (AIS) within a few minutes is important but difficult. We examined whether a new thrombolysis program can decrease the door-to-needle (DTN) time when treating patients with AIS. METHODS:A new rtPA thrombolysis program with video assistance was adapted for patients with AIS and their families. We retrospectively compared outcome quality before (2009-2011) and after (2012) the program began. Outcomes included DTN time, the percentage of rtPA thrombolysis within 3 hours of onset in all hospitalized patients with AIS who presented within 2 hours of onset (2 hr%) and the percentage of rtPA thrombolysis in all hospitalized patients with AIS (AIS%). RESULTS:We recruited patients with AIS who had undergone thrombolytic therapy before (n = 18) and after (n = 14) the initiation of the new program. DTN time decreased (93 ± 24 minutes to 57 ± 14 minutes, p < 0.001) and the AIS% increased (2% to 5%, p = 0.010) after the program. The 2 hr% marginally significantly increased (18% to 33%, p = 0.080). CONCLUSION:A thrombolysis program with video-assisted therapeutic risk communication decreased DTN time and increased the treatment rate of patients with AIS.