The New York State Coverdell Stroke Quality Improvement and Registry Program (Coverdell)

Initiative to Improve Timely Delivery of t-PA

This initiative was implemented from October-December 2013 after a Core Collaborative Leadership Team and Learning Session Team Leaders were identified. During the collaborative action period, several learning calls about strategies to reduce the time to t-PA took place with team updates and reports due each month. Following this action period, a post-action period took place from January-March 2014.

Results:

  • Percentage of NYS Ischemic stroke patients receiving t-PA within 60 minutes:
    • Higher overall in Coverdell hospitals than other NYS hospitals
    • Increased significantly from the quarter before (1) the Learning Collaborative (LC) to during (2) the LC period in Coverdell hospitals
    • Increased significantly from the quarter before (1) the LC to the time during and after (2 & 3) the LC for both Coverdell and other NYS hospital groups.
    Percentage NYS IS Pts Receiving t-PA 60 Min
  • Median minutes of NYS Coverdell Ischemic stroke patients receiving t-PA from hospital arrival:
    • Significantly lower during the 9 month study period than the other NYS hospitals
    • Declined significantly from 70 minutes to 55 minutes over the 9 month study period
    Median Minutes Receiving t-PA from Arrival

Target:Stroke Best Practices for Reducing Time to IV-t-PA Administration

  1. Hospital pre-notification by Emergency Medical Services
  2. Rapid triage protocol and stroke team notification
  3. Single call/paging activation system for entire stroke team
  4. Use of stroke toolkit containing clinical decision support, stroke specific order sets, guidelines, hospital-specific algorithms, critical pathways, NIH Stroke Scale and other tools
  5. Rapid acquisition and interpretation of brain imaging
  6. Rapid laboratory testing (including point-of-care testing) if indicated
  7. Pre-mixing t-PA medication ahead of time for high likelihood candidates
  8. Rapid access to intravenous t-PA in the ED/brain imaging area
  9. Team-based approach
  10. Rapid data feedback to stroke team on each patient's DTN time/related data