Multimodal strategy in the successful implementation of a stroke unit in a community hospital

Objectives - Thrombolysis in stroke remains underutilized in daily practice. We analyzed the impact of a multimodal strategy on the rate of thrombolysis and specific procedure times during the implementation of a community hospital stroke unit. Material and methods - During a period of 2 years before and after implementation of a stroke unit, we prospectively recorded all patients with thrombolysis and specific procedure times. Calculated door-to-needle time (DNT), door-to-CT time (DCT) and CT-to-needle time (CNT) were analyzed. All structural changes before and after the implementation were analyzed. Results - The number of patients with thrombolysis increased from 24 in 2005-2006 (4.8% of all admitted patients with ischemic stroke) to 95 in 2007-2008 (12.8%). DNT was significantly reduced from 62.2 +/- 36.1 to 38.5 +/- 22.2 min (P < 0.001). DCT remained unchanged at 10.3 +/- 9.5 to 10.4 +/- 13.9 min (P = 0.974), whereas CNT improved from 45.7 +/- 23.1 to 28.3 +/- 20.3 min (P = 0.001). Several structural changes concerning staff, logistics, procedures and laboratory were identified which contributed to decreasing DNT. Conclusions - A multimodal strategy including several structural changes enables the successful implementation of a community hospital stroke unit offering rapid access to thrombolysis with a very short DNT.