Door-to-needle time for thrombolysis: a secondary analysis of the TIPS cluster randomised controlled trial

• Published in: BMJ open Vol. 9; no. 12; p. e032482
• Main Authors: Hasnain, Md Golam, Paul, Christine L, Attia, John R, Ryan, Annika, Kerr, Erin, D'Este, Catherine, Hall, Alix, Milton, Abul Hasnat, Hubbard, Isobel J, Levi, Christopher R
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 15.12.2019; BMJ Publishing Group
• Subjects: Administration, Intravenous; Aged; Aged, 80 and over; Australia; Brain Ischemia - drug therapy; Collaboration; Emergency Medical Services; Female; Fibrinolytic Agents - administration & dosage; Health Services Research; Hospitals; Humans; Intervention; Ischemia; Male; Middle Aged; Patients; Performance evaluation; Regression Analysis; Stroke; Stroke - drug therapy; Thrombolytic Therapy - methods; Time-to-Treatment; Treatment Outcome; Australia; intravenous thrombolysis; door-to-needle time; implementation intervention; ischemic stroke
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2019-032482

ObjectiveThe current study aimed to evaluate the effects of a multi-component in-hospital intervention on the door-to-needle time for intravenous thrombolysis in acute ischaemic stroke.DesignThis study was a post hoc analysis of door-to-needle time data from a cluster-randomised controlled trial testing an intervention to boost intravenous thrombolysis implementation.SettingThe study was conducted among 20 hospitals from three Australian states.ParticipantEligible hospitals had a Stroke Care Unit or staffing equivalent to a stroke physician and a nurse, and were in the early stages of implementing thrombolysis.InterventionThe intervention was multifaceted and developed using the behaviour change wheel and informed by breakthrough collaborative methodology using components of the health behaviour change wheel.Primary and secondary outcome measuresThe primary outcome for this analysis was door-to-needle time for thrombolysis and secondary outcome was the proportion of patients received thrombolysis within 60 min of hospital arrival.ResultsThe intervention versus control difference in the door-to-needle times was non-significant overall nor significant by hospital classification. To provide additional context for the findings, we also evaluated the results within intervention and control hospitals. During the active-intervention period, the intervention hospitals showed a significant decrease in the door-to-needle time of 9.25 min (95% CI: -16.93 to 1.57), but during the post-intervention period, the result was not significant. During the active intervention period, control hospitals also showed a significant decrease in the door-to-needle time of 5.26 min (95% CI: −8.37 to −2.14) and during the post-intervention period, this trend continued with a decrease of 12.13 min (95% CI: -17.44 to 6.81).ConclusionAcross these primary stroke care centres in Australia, a secular trend towards shorter door-to-needle times across both intervention and control hospitals was evident, however the TIPS (Thrombolysis ImPlementation in Stroke) intervention showed no overall effect on door-to-needle times in the randomised comparison.Trial registration numberTrial Registration-URL: http://www.anzctr.org.au/ Unique Identifier: ACTRN 12613000939796.