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Abstract W P267: Utilizing a Team-Based Educational Approach to Increase IV rt-PA Treatment Rates at a Community-Based Target: Stroke Honor Roll Designated Primary Stroke Center (PSC) in Urban Los Angeles


 Background:
 Intravenous recombinant tissue plasminogen activator (IV rt-PA) is the only FDA approved treatment for acute ischemic stroke offering at least a 30% chance of improvement over placebo, however, IV rt-PA treatment rates tend to remain low with the national average of ischemic stroke patients being treated with IV rt-PA near 2%.
 
 
 Purpose:
 To utilize a team-based educational approach in order to maintain Target: Stroke Honor Roll status and increase IV rt-PA treatment rates from 20.4% in 2011 at a community-based PSC in urban Los Angeles for patients presenting with acute ischemic stroke from Jan 1, 2012 to Dec 31, 2012.
 
 
 Methods:
 A team based educational approach was utilized to increase IV rt-PA treatment rates in the Emergency Department (ED) by addressing topics such as benefits of IV rt-PA , stroke mimics, IV rt-PA exclusion criteria and eligibility criteria, stroke code activation, the consent process, and neurological assessment. The education was provided throughout the year and reinforced during monthly meetings, on-going in services, an annual stroke symposium, and during annual skill competency days across departments. These educational opportunities and meetings included physicians, RNs, radiology technicians, lab technicians, rehabilitation therapists, social workers, pharmacists, and case managers. Baseline year end data in 2011 was compared to year end data in 2012. In-patient mortality rates were also compared.
 
 
 Results:
 For 2012, the proportion of patients who received IV rt-PA treatment increased to 25.8% (62/240 total acute non-tPA ischemic strokes), up from 20.4% (50/244 total acute non-tPA ischemic strokes) in 2011. For 2012, the in-patient mortality rate for IV rt-PA receiving patients decreased to 3.22% (2/62) from the 2011 in-patient mortality rate of 4% (2/50).
 
 
 Conclusions:
 Target: Stroke Honor Roll status was maintained and the strategic goal to increase IV rt-PA treatment rates for acute ischemic stroke from 20.4% in 2011 to 25.8% in 2012 was met. Our IV rt-PA treatment rates were significantly higher than the national average of 2%. In addition, the mortality rate decreased from 4% in 2011 to 3.22% in 2012 despite the increase in IV rt-PA treatment rates, demonstrating the safety of IV rt-PA treatment in this population.
