Neurohospitalists Improve Door-to-Needle Times for Patients With Ischemic Stroke Receiving Intravenous tPA

Purpose: It is unknown whether neurohospitalist evaluation improves door-to-needle times (DNT) in patients with acute ischemic stroke. The purpose of this study is to determine the impact of neurohospitalist evaluation on DNT for patients with ischemic stroke receiving intravenous tissue plasminogen activator (tPA) presenting within 4.5 hours of symptom onset. Methods: We retrospectively identified consecutive patients with ischemic stroke who received tPA between 0 and 4.5 hours. We determined and compared DNT for nonneurohospitalists versus neurohospitalists for a 26-month period from 2009 to 2011. Our main outcome measure was percentage of patients receiving tPA within 60 minutes. Results: Overall, out of the 107 consecutive ischemic stroke patients (mean age 67 years) who received intravenous tPA within 4.5 hours, 60 patients were evaluated by nonneurohospitalists (community and locums neurologists) and 47 patients were evaluated by neurohospitalists. Mean +/- standard deviation (SD) DNT with patients treated by nonneurohospitalists (93 +/- 24 minutes) were significantly longer than the DNT treated by neurohospitalists (68 +/- 18 minutes). Twenty-four patients (51%) treated by neurohospitalists had DNT less than or equal to 60 minutes, while 9 patients (15%) treated by nonneurohospitalists had DNT less than or equal to 60 minutes. Multivariate analysis showed that neurohospitalist evaluation (odds ratio [OR] 5.4, confidence interval [CI] 2.2-13.6, P = .022) was the only independent factor associated with patients receiving tPA within 60 minutes. Conclusion: Neurohospitialist evaluation is associated with faster DNT in patients with ischemic stroke. Neurohospitalist evaluation could be a part of a multidimensional initiative to improve the timeliness of tPA administration.