A successful treatment strategy includes analyzing process and identifying missed eligible patients 24,25
Examine discharge data
Review files of patients with a discharge diagnosis of AIS
Identify missed eligible patients
Determine eligibility according to Activase prescribing information
Compile reasons for non-treatment
Analyze trends for non-treatment of missed eligible patients
Share findings at regular team meetings
Develop strategies to help identify and treat all eligible patients
Execute quality improvement strategies
Continually track performance and outcomes, refine strategies
Frequent causes for slower treatment with Activase include difficulties in determining patient eligibility, delayed diagnoses, and in-hospital delays, which can add over 25 minutes to the door-to-needle time and negatively impact patient outcomes.
BASED ON YOUR METRICS, WHAT IS THE MOST COMMON REASON FOR NOT TREATING WITH ACTIVASE?
Door-to-Needle (DTN) time
Delays in DTN time can impact patients. 2
AIS is a serious medical emergency. Multiple parallel processes can help expedite treatment for patients with AIS who are eligible for Activase with or without subsequent mechanical thrombectomy. 6,26-29
*Certain patient evaluations and diagnoses may be performed using telestroke services. 27,29,31
†In centers without capabilities to perform mechanical thrombectomy, patients should begin receiving Activase before being transferred for treatment at an experienced stroke center.
CT=computed tomography; CTA=computed tomography
angiogram; ED=emergency department; EMS=emergency medical services;
LVO=large vessel occlusion.
WHAT'S YOUR DTN TARGET?
Find out if your team is aligned with time-saving
recommendations from Target: Stroke
Five time-saving strategies employed by world-class hospitals to reduce DTN time include 27:
- Overall emergency medical services prenotification
- Neurology evaluation via secure telecommunication en route
- Transfer directly to imaging – multiple assessments occur in parallel and patient bypasses ED bed
- Point-of-care laboratory testing
- Administering Activase immediately after CT excludes a hemorrhagic stroke
Learn more about how top stroke institutions are changing their process with the Parallel Process Initiative Case Study
Identifying missed eligible patients
Evaluating all patients with AIS is a better way to view and
understand the full AIS patient pool at your institution. Healthcare
professionals may have differing criteria when evaluating
appropriateness for Activase treatment, based on:
- The label Indication, Contraindications, and Warnings and Precautions
- Individual hospital protocols
- Personal treatment philosophy
Constant evaluation of processes implemented within an institution can have a meaningful impact in identifying missed eligible patients.
HOW DO YOU USE METRICS TO IDENTIFY MISSED ELIGIBLE PATIENTS? WHAT TOOLS DO YOU USE?
Use stroke program initiatives to track All-AIS
Tracking every patient discharged from your hospital with a confirmed AIS diagnosis, tracking All-AIS, is a way to increase knowledge of the patient pool. It can provide valuable insights into understanding why patients at your institution may or may not be treated and help identify potential gaps.
- What are the most common reasons for not treating with Activase and how do these reasons align with Activase prescribing information-based eligibility criteria?
- Does this report reflect the institution's current stroke treatment protocol?
- How does your pool of AIS patients fit within protocol and guidelines criteria?
Reach out to your Get With The Guidelines (GWTG) representative for help with GWTG reports
Reasons for non-treatment may already be tracked at your institution. Hospitals using GWTG must document reasons for non-treatment for all AIS patients who did not receive Activase. Consider evaluating GWTG reports such as, Reasons for no intravenous Activase, illustrated in the sample below, as they can provide insights into critical trends regarding your patient pool.
WHEN EVALUATING ALL-AIS, DOES PATIENT ELIGIBILITY
REFLECT WHAT IS CURRENTLY IN YOUR HOSPITAL PROTOCOL? IS
DID YOU KNOW?
- Evaluating and improving processes, such as door-to-needle
time, may lead to higher rates of Activase treatment of appropriate
- Hospitals are constantly striving to improve their stroke process. Review the case studies presented in this section to learn more.