Target Stroke Implementation: Best Practice Strategies Cut Thrombolysis Time to < 30 minutes in a 1,550 Bed Academic Urban County Hospital (P4.280)

Objective: We assessed long-term efficacy of implementation of AHA/ASA Target: Stroke Best Practice Strategies (TSBPS) to improve thrombolysis door-to-needle (DTN) time in a tertiary care hospital. Background: Therapeutic window for acute ischemic stroke (AIS) with IV rt-PA is brief and crucial. TSBPS aim to help hospitals improve DTN time. Design/Methods: We initiated a quality improvement program across one academic medical center (1,550 beds, 900 annual stroke admissions) that serves a multi-ethnic population by establishing a multidisciplinary DTN committee to assess causes of delayed DTN and implement focused TSBPS. Strategies included stroke team pre-admission notification, direct transfer to CT, storing/administering IV rt-PA at CT scanner, and immediate stakeholder feedback. We analyzed door-to-CT time, DTN time, CT to IV rt-PA time, and door-to-groin (DTG) time, in consecutive IV rt-PA treated patients over 27 months pre-implementation and 13 months post-implementation. Results: We analyzed 148 patients in the pre-implementation and 126 in the post-implementation group. We found no significant difference in the pre-implementation and post-implementation groups in demographics, comorbidities, anticoagulation status, pre-thrombolysis hypertension treatment, stroke severity (median NIHSS 11 (6–18) vs. 11 (5–17), p= 0.483), arrival by EMS (96% vs. 97%, p=0.708), or arrival after hours. After implementation, reductions in treatment times were observed for median DTN (IQR) 59 (52–80) to 28.5 (20–41) min (p Conclusions: Individualized hospital gap analysis identifies targeted interventions to shorten treatment times. DTN and DTG time can be reduced with implementation of simple, low-cost interventions, with persistent effect and no increase in symptomatic intracranial hemorrhage or stroke mimic treatment. Disclosure: Dr. Marulanda-Londono has nothing to disclose. Dr. Bhatt has nothing to disclose. Dr. Atchaneeyasakul has nothing to disclose. Dr. Asdaghi has nothing to disclose. Dr. Malik has nothing to disclose. Dr. Akram has nothing to disclose. Dr. Zhang has nothing to disclose. Dr. D’Amour has nothing to disclose. Dr. Hesse has nothing to disclose. Dr. Sacco has received research support from Boehringer Ingelheim Pharmaceuticals. Dr. Romano has received personal compensation for activities with NovaVision as an advisory board member and consultant.