Modified Helsinki Model Reduced Stroke Thrombolysis Delays In A Resource Limited, Non-Metropolitan Australian Hospital (RLNMAH) (P7.128)

Objective: We tested whether comparable results can be achieved following some system changes similar to The Helsinki model at The Western Health a RLNMAH. Background: Thrombolysis is the only proven acute treatment for acute ischemic stroke. Current utilization of stroke thrombolysis is suboptimal (administered in less than 3% of cases in most health services). Inefficient in hospital care systems (suboptimal triage, delay in neuroimaging etc) create major barriers to offering treatment in a timely manner. The Helsinki stroke thrombolysis model achieved a median 20-minute door to needle time (DNT) by adopting steps to eliminate barriers. It is important to test the transferability of key components of this protocol in a different health care setting. Methods: In September 2012, The Western Health adopted ambulance prenotification of Emergency (ED) and stroke unit staff, pre-registration of patients by clerks and direct transfer to CT. Our tPA registry was analyzed prospectively to compare the door to CT and door to needle times between patients treated 8 months before and one year after these system changes. The results were analysed using a Mann Whitney Wilcoxon test. Results: The Unit thrombolysed 31 patients from January to August 2012 and 60 patients from September 2012 to September 2013. The door to CT time decreased from a median of 40 (interquartile range 25-71) to 30 (19-63) minutes (p=0.26) and the door to needle time from 98 (72-140) to 93 (73-116) minutes (p=0.34). There was also benefit seen in patients who presented outside working hours (5pm-8am and weekends), where the door to CT time reduced from 68 (29-98) to 38 (15-63) minutes (p=0.1) and door to needle time from 130 (92-164) to 108 (78-136) minutes (p=0.32). Conclusion: The study suggests that adopted changes lead to a favorable trend towards optimization of thrombolysis in a RLNMAH. Disclosure: Dr. Vijiaratnam has nothing to disclose. Dr. Mackey has nothing to disclose. Dr. Tu has nothing to disclose. Dr. Matkovic has nothing to disclose. Dr. Wijeratne has nothing to disclose.