Overcoming Barriers to Reduce Door to Needle Times in Acute Ischemic Stroke Patients: Field to CT (P6.008)

OBJECTIVE/BACKGROUND: Time lost, is brain lost. The ASA’s Target Stroke strategies were reviewed to improve Door to CT (DTCT) and Door to Needle (DTN) times. Taking acute stroke patients direct from triage to the CT scanner can reduce thrombolysis treatment times, which may improve patient outcomes. In April 2015, the JFK Comprehensive Stroke Center introduced a Direct to CT policy for acute stroke patients who are assessed to be acute by the JFK EMS service. The purpose was to look at feasibility and maintenance of quality when applied to a larger subset of patients. DESIGN/METHODS: We performed a prospective pilot study comparing door-to-CT times (DTCT) and door-to-needle (DTN) times pre- and post-implementation of Direct to CT policy, and analyzed patient characteristics, Emergency Department (ED) presentation time, adverse effects, protocol violations and patient outcomes. Delays in treatment, enablers and barriers to treatment were also examined. RESULTS: There was no statistical difference in demographics or clinical factors in patients who presented pre- (2013, 2014, n= 621) or post- Direct to CT (April 20-June 20, 2015 n=22). However, a reduction in mean DTCT times (21 mins vs. 8.7 mins, p<.0001) and DTN times (55 mins vs. 19 mins, p<.0001) was seen. There was no increase in adverse outcomes (7[percnt] vs. 0[percnt]) in patients taken Direct to CT. CONCLUSION: Taking patients Direct to CT has significantly reduced time to evaluation, DTCT, and DTN.. Numerous barriers to Direct to CT were identified at the pre-hospital, ED, CT and stroke team levels. Some of these concerns are ongoing and will take time and effort to overcome. Strengths noted were the EMS capability of pre-hospital Intravenous line establishment, blood draws, and EKG performance as well as IV tPA initiation in the CT area. Disclosure: Dr. Panezai has nothing to disclose. Dr. Chukwuneke has nothing to disclose. Dr. Arango has nothing to disclose. Dr. Brar has nothing to disclose. Dr. Daniel has nothing to disclose. Dr. Korya has nothing to disclose. Dr. Mehta has nothing to disclose. Dr. Moussavi has nothing to disclose. Dr. Kirmani has nothing to disclose.