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Perception Versus Actual Performance in Timely Tissue Plasminogen Activation Administration in the Management of Acute Ischemic Stroke

BACKGROUND: Timely thrombolytic therapy can improve stroke outcomes. Nevertheless, the ability of US hospitals to meet guidelines for intravenous tissue plasminogen activator (tPA) remains suboptimal. What is unclear is whether hospitals accurately perceive their rate of tPA “door-to-needle” (DTN) t...

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Autores principales: Lin, Cheryl B, Cox, Margueritte, Olson, DaiWai M, Britz, Gavin W, Constable, Mark, Fonarow, Gregg C, Schwamm, Lee, Peterson, Eric D, Shah, Bimal R
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley & Sons, Ltd 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4608060/
https://www.ncbi.nlm.nih.gov/pubmed/26201547
http://dx.doi.org/10.1161/JAHA.114.001298
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author Lin, Cheryl B
Cox, Margueritte
Olson, DaiWai M
Britz, Gavin W
Constable, Mark
Fonarow, Gregg C
Schwamm, Lee
Peterson, Eric D
Shah, Bimal R
author_facet Lin, Cheryl B
Cox, Margueritte
Olson, DaiWai M
Britz, Gavin W
Constable, Mark
Fonarow, Gregg C
Schwamm, Lee
Peterson, Eric D
Shah, Bimal R
author_sort Lin, Cheryl B
collection PubMed
description BACKGROUND: Timely thrombolytic therapy can improve stroke outcomes. Nevertheless, the ability of US hospitals to meet guidelines for intravenous tissue plasminogen activator (tPA) remains suboptimal. What is unclear is whether hospitals accurately perceive their rate of tPA “door-to-needle” (DTN) time within 60 minutes and how DTN rates compare across different hospitals. METHODS AND RESULTS: DTN performance was defined by the percentage of treated patients who received tPA within 60 minutes of arrival. Telephone surveys were obtained from staff at 141 Get With The Guidelines hospitals, representing top, middle, and lowDTN performance. Less than one-third (29.1%) of staff accurately identified their DTN performance. Among middle- and low-performing hospitals (n=92), 56 sites (60.9%) overestimated their performance; 42% of middle performers and 85% of low performers overestimated their performance. Sites that overestimated tended to have lower annual volumes of tPA administration (median 8.4 patients [25th to 75th percentile 5.9 to 11.8] versus 10.2 patients [25th to 75th percentile 8.2 to 17.3], P=0.047), smaller percentages of eligible patients receiving tPA (84.7% versus 89.8%, P=0.008), and smaller percentages of DTN ≤60 minutes among treated patients (10.6% versus 16.6%, P=0.002). CONCLUSIONS: Hospitals often overestimate their ability to deliver timely tPA to treated patients. Our findings indicate the need to routinely provide comparative provider performance rates as a key step to improving the quality of acute stroke care.
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spelling pubmed-46080602015-10-16 Perception Versus Actual Performance in Timely Tissue Plasminogen Activation Administration in the Management of Acute Ischemic Stroke Lin, Cheryl B Cox, Margueritte Olson, DaiWai M Britz, Gavin W Constable, Mark Fonarow, Gregg C Schwamm, Lee Peterson, Eric D Shah, Bimal R J Am Heart Assoc Original Research BACKGROUND: Timely thrombolytic therapy can improve stroke outcomes. Nevertheless, the ability of US hospitals to meet guidelines for intravenous tissue plasminogen activator (tPA) remains suboptimal. What is unclear is whether hospitals accurately perceive their rate of tPA “door-to-needle” (DTN) time within 60 minutes and how DTN rates compare across different hospitals. METHODS AND RESULTS: DTN performance was defined by the percentage of treated patients who received tPA within 60 minutes of arrival. Telephone surveys were obtained from staff at 141 Get With The Guidelines hospitals, representing top, middle, and lowDTN performance. Less than one-third (29.1%) of staff accurately identified their DTN performance. Among middle- and low-performing hospitals (n=92), 56 sites (60.9%) overestimated their performance; 42% of middle performers and 85% of low performers overestimated their performance. Sites that overestimated tended to have lower annual volumes of tPA administration (median 8.4 patients [25th to 75th percentile 5.9 to 11.8] versus 10.2 patients [25th to 75th percentile 8.2 to 17.3], P=0.047), smaller percentages of eligible patients receiving tPA (84.7% versus 89.8%, P=0.008), and smaller percentages of DTN ≤60 minutes among treated patients (10.6% versus 16.6%, P=0.002). CONCLUSIONS: Hospitals often overestimate their ability to deliver timely tPA to treated patients. Our findings indicate the need to routinely provide comparative provider performance rates as a key step to improving the quality of acute stroke care. John Wiley & Sons, Ltd 2015-07-23 /pmc/articles/PMC4608060/ /pubmed/26201547 http://dx.doi.org/10.1161/JAHA.114.001298 Text en © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Research
Lin, Cheryl B
Cox, Margueritte
Olson, DaiWai M
Britz, Gavin W
Constable, Mark
Fonarow, Gregg C
Schwamm, Lee
Peterson, Eric D
Shah, Bimal R
Perception Versus Actual Performance in Timely Tissue Plasminogen Activation Administration in the Management of Acute Ischemic Stroke
title Perception Versus Actual Performance in Timely Tissue Plasminogen Activation Administration in the Management of Acute Ischemic Stroke
title_full Perception Versus Actual Performance in Timely Tissue Plasminogen Activation Administration in the Management of Acute Ischemic Stroke
title_fullStr Perception Versus Actual Performance in Timely Tissue Plasminogen Activation Administration in the Management of Acute Ischemic Stroke
title_full_unstemmed Perception Versus Actual Performance in Timely Tissue Plasminogen Activation Administration in the Management of Acute Ischemic Stroke
title_short Perception Versus Actual Performance in Timely Tissue Plasminogen Activation Administration in the Management of Acute Ischemic Stroke
title_sort perception versus actual performance in timely tissue plasminogen activation administration in the management of acute ischemic stroke
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4608060/
https://www.ncbi.nlm.nih.gov/pubmed/26201547
http://dx.doi.org/10.1161/JAHA.114.001298
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