Fast administration of clot-busting medication is crucial for reducing both short- and long-term effects of ischemic stroke. But according to new research, hospitals may not be performing as well in this area as they think they are.

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Current guidelines recommend that ischemic stroke patients receive clot-busting medication within 60 minutes of hospital arrival to lower the risk of short- and long-term complications.

By surveying staff from more than 140 US hospitals who treated almost 50,000 stroke patients in 2009-10, researchers found less than a third of hospital staff accurately identified their stroke care performance, with many hospitals overestimating how quickly they administered clot-busting medication.

Lead study author Dr. Cheryl Lin, a former researcher at Duke Clinical Research Institute in Durham, NC, and colleagues publish their findings in the Journal of the American Heart Association.

Each year, more than 795,000 people in the US have a stroke. Around 87% of strokes are ischemic, in which blood flow to the brain is blocked, most commonly as a result of blood clots.

Tissue plasminogen activator (tPA) is the only medication approved by the US Food and Drug Administration (FDA) for the treatment of ischemic stroke. It works by breaking down blood clots, improving blood flow to the brain.

Current guidelines recommend that ischemic stroke patients receive tPA within 60 minutes of hospital arrival; previous research suggests the quicker the drug is administered, the lower the chance of short- and long-term complications.

For their study, Dr. Lin and colleagues set out to determine whether the perception of hospital staff regarding their stroke care performance matched up with their actual performance.

The team surveyed staff from 141 hospitals in the US. In 2009 and 2010, the staff had treated 48,201 stroke patients. The staff were asked how quickly they administer tPA medication to stroke patients on hospital arrival – called “door-to-needle” time.

Patient data was also gathered, detailing the onset of stroke symptoms, the time of hospital arrival, at what point they received tPA and any complications they experienced as a result of the medication.

Hospitals were placed into three categories – high-, middle- or low-performing – based on their actual door-to-needle time.

The researchers found that only 29% of hospital staff identified their door-to-needle time correctly, and almost 20% of low-performing hospitals believed their door-to-needle performance was above the national average.

Around 85% of low-performing hospitals and 42% of middle-performing hospitals overestimated their ability to administer tPA to stroke patients quickly, according to the results, and these hospitals had lower volumes of tPA administration.

The researchers found that the volume of stroke patients arriving at hospitals was one factor that influenced the identified disparity between hospital perception of tPA administration and actual performance, while hospital size and region were not found to be key contributors.

Based on these findings, Dr. Lin says:

Institutions at any performance level could benefit from making protocol changes that would better align performance with perception. This would have a significant impact on the quality of stroke care delivered across the US.”

In February, Medical News Today reported on a study claiming it is feasible for paramedics to administer tPA medication to stroke patients prior to hospital arrival.

On testing the theory in 1,700 patients with suspected stroke, the research team found that 74.3% of patients received a study drug within 60 minutes of symptom onset.