A simple, real-time text-messaging intervention may be associated with significant improvement in door-to-needle (DTN) times for acute ischemic stroke, according to a study published Oct. 28 in Stroke.

Timely administration of intravenous tissue-type plasminogen activator (IV tPA) has consistently been connected with improved outcomes for acute ischemic stroke. With current guidelines recommending that the administration of IV tPA be within 60 minutes of arrival to the emergency department, and recent reports demonstrating that median DTN times of 20 minutes are achievable, new methods are continually being designed to better the process. Taking advantage of mobile technology Molly Burnett, MD, Department of Neurology, University of California, San Francisco, and her colleagues developed, implemented, and evaluated a text-message-based intervention called Code Stroke to provide real-time feedback with the hope of improving DTN times.

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Evaluating the impact of the intervention, Burnett et al. compiled longitudinal data on consecutive adults treated with IV tPA for acute ischemic stroke that presented to the emergency department at their care center from January 2008 to April 2014, encompassing the three years before and three years after the intervention was implemented in April 2011.

Results of the study showed that total of 94 patients were treated in the pre-intervention period and 108 patients were treated in the post-intervention period. Compared to the pre-intervention period, the median DTN time was significantly lower in the post-intervention period (82 minutes [IQR 68-103] to 56 minutes [IQR 44-71]), with a higher proportion of patients treated within 60 minutes (63 percent vs. 16 percent). Based on the data’s linear trend, the authors observed a 14.9 minute improvement in DTN times (95 percent CI 0.56–29.3, P=0.04) that coincided with the rollout of the intervention.

Detailing the further benefits of their investigation, Burnett and her co-authors write, “Our intervention was designed to focus the team on a specific performance goal and to provide timely feedback on performance against that goal but did not require a large investment of resources or staff time, or changes in existing protocols since we left it to team leaders to define how the goal was to be achieved.  Quality improvement efforts that rely on retrospective review can often provide feedback only weeks or months later. In practice settings where staff rotate frequently, this feedback can arrive too late to change clinical practice. In contrast, a real-time reporting mechanism allows for a tighter feedback loop while the clinical details of a particular case are still fresh in the minds of team members. It may also serve to increase accountability for DTN performance – an especially relevant issue at centers where staff turnover can contribute to a diffusion of accountability.”

Keywords: Quality Improvement, Stroke, San Francisco, Social Responsibility, Emergency Service, Hospital, Text Messaging, Tissue Plasminogen Activator

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