Abstract W P188: Achieving Sub-20min tPA Door-to-needle Times - the Importance of Patient Details on Prenotification and Point-of-care INR

Background and purpose: Institutions around the world have re-engineered acute stroke care to achieve dramatic reductions in tPA door-to-needle times (DNT). We investigated the effects of specific process elements on DNT. Methods: The “code stroke” system at Royal Melbourne Hospital was systematically evaluated and redesigned in 2012 to take patients directly from triage to CT on ambulance stretchers and deliver tPA on the CT table. We studied the 12 months post implementation data within business hours (when stroke team members were located in the hospital) for effects of variably utilized key components of the new system - ambulance pre-notification including patient name and date of birth (allowing transfer direct to CT), and point-of-care (POC)-INR. Results: In the 12 months post-implementation, 40/80 (50%) of patients who received tPA were treated in-hours. In-hours DNT reduced from pre-implementation median 43 min to 23 min (p<0.001). However, only 33% of the patients had full pre-notification inclu...