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 Researchers asked hospital staff how fast they administered an
intravenous (IV) therapy known as thrombolysis to dissolve clots and
compared the answers to stroke registry data with the actual times.
Only 29 percent of hospitals had an accurate sense of their own
speed, and the slower hospitals mostly overestimated their own
performance, the study found.
“Everyone likes to think that they are doing better,” senior study
author Dr. Bimal Shah, a researcher at Duke University School of
Medicine, said by email. “Not acting quickly makes the prognosis for
stroke patients worse.”
Globally, 15 million people suffer strokes each year; five million
of them die and another five million are left permanently disabled,
according to the World Health Organization.
Initial symptoms can include drooping or numbness on one side of the
face, lack of feeling or mobility in one arm or slurred, impaired
speech.
Thrombolysis can be used within three hours of when stroke symptoms
start, as long as patients haven’t recently had a heart attack,
stroke or head injury and don’t have other medical complications
that might make the treatment unsafe. Some patients under 80 may be
able to receive the treatment within 4.5 hours, according to past
research.
The drugs delivered in IV thrombolysis can be effective for ischemic
stroke, which results from an obstruction in a blood vessel
supplying the brain and is the most common type of stroke.
Because speed is crucial, Shah and colleagues focused on what they
describe as the “door-to-needle” time, or the time from when
patients enter the hospital door to when IV therapy begins.
Overall, the 141 hospitals in the study admitted 48,201 stroke
patients. The researchers ranked the hospitals based on the
percentage of patients who received the IV therapy within an hour of
arrival.
The top-performing hospitals tended to treat more ischemic stroke
patients each year and to perform thrombolysis in more patients.
Staff at these facilities estimated that more than 60 percent of
patients were treated within an hour of arrival, while in reality it
was about 57 percent.
The gap between perception and reality was far bigger for hospitals
that were generally slower.
Among the lowest-performing hospitals, staff surveyed generally
thought that at least 20 percent of treated patients got the therapy
within an hour. In reality, none did.
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Despite their lack of speed, 85 percent of the low-performing
hospitals reported their performance as average or above, with
almost 5 percent of them ranking themselves as superior in
comparison with other hospitals nationwide.
One limitation of the study is that it only included hospitals that
participate in voluntary national stroke registries, the researchers
note in the Journal of the American Heart Association. In addition,
only one staff person at each hospital was interviewed for the
study, making it possible the results would differ based on the
individual participating.
Moreover, hospitals aren’t the only players in this race against the
clock, Shah said. Patients need to call for an ambulance immediately
when they notice any potential symptoms of a stroke.
“The common mistake is to delay seeking medical attention when first
exhibiting symptoms,” Shah said.
How long it takes patients with ischemic stroke to receive
thrombolysis is one of the best predictors of their outcomes, said
Dr. Shazam Hussain, head of the stroke program at Cleveland Clinic
in Ohio.
Less than half of patients in the U.S. are treated within the
recommended door-to-needle time of 60 minutes, Hussain, who wasn’t
involved in the study, said by email.
“This study sheds important light on one of the reasons why overall
we are struggling meeting this target,” Hussain said. “Hospitals and
practitioners feel they are performing well and may not be devoting
the proper resources to fully analyze their data to see the true
situation.”
SOURCE: http://bit.ly/1LuyEf6 Journal of the American Heart
Association, online July 22, 2015.
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