• Ying Xian, Eric E Smith, Xin Zhao, Eric D Peterson, DaiWai M Olson, Adrian F Hernandez, Deepak L Bhatt, Jeffrey L Saver, Lee H Schwamm, and Gregg C Fonarow.
• From the Duke Clinical Research Institute, Durham, NC (Y.X., X.Z., E.D.P., A.F.H.); Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology & Neurotherapeutics, Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (D.M.O.); Department of Neurology, University of California, Los Angeles (J.L.S.); Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.L.B.); Stroke Service, Massachusetts General Hospital, Boston (L.H.S.); and Division of Cardiology, University of California, Los Angeles (G.C.F.).
• Stroke. 2014 May 1;45(5):1387-95.

Background And PurposeThe benefits of intravenous tissue-type plasminogen activator in acute ischemic stroke are time dependent, and several strategies have been reported to be associated with more rapid door-to-needle (DTN) times. However, the extent to which hospitals are using these strategies and their association with DTN times have not been well studied.MethodsWe surveyed 304 Get With The Guidelines-Stroke hospitals joiningTargetStroke regarding their baseline use of strategies to reduce DTN times in the January 2008 to December 2009 time frame before the initiation ofTargetStroke and determined the association between hospital strategies and DTN times.ResultsAmong 5460 patients receiving tissue-type plasminogen activator within 3 hours of symptom onset in surveyed hospitals, the median DTN time was 72 minutes (interquartile range, 55-94). Reported use of the different strategies varied considerably. Of 11 hospital strategies analyzed individually by multivariable analysis, 3 strategies were independently associated with shorter DTN times. These included rapid triage/stroke team notification (209/304 [69%] hospitals, 8.1-minute reduction in DTN time), single-call activation system (190/304 [63%] hospitals, 4.3 minutes), and tissue-type plasminogen activator stored in the emergency department (189/304 [62%] hospitals, 3.5 minutes). When analyzed incrementally, hospitals that used a greater number of strategies had shorter DTN times with 1.3 minutes (adjusted mean difference) saved for each strategy implemented (14 minutes if all strategies were used).ConclusionsAlthough the majority of participating hospitals reported using some strategy to reduce delays in tissue-type plasminogen activator administration for acute ischemic stroke, the strategies applied vary considerably and those most strongly associated with shorter DTN times were applied relatively less frequently.

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