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Dramatic Improvements In Stroke Treatment, Enhanced Use Of tPA

DALLAS, TX -- March 14, 2000 -- A six-month effort involving more than 40 hospitals has resulted in an almost 50 percent reduction in the time from a patient's arrival at the hospital to diagnostic results based on a computerized tomography (CT) scan. The initiative, part of the Clinical Advantage program of the VHA hospital alliance, focused on improving a number of processes health care providers use to evaluate and treat stroke patients. The time reduction is critical to saving lives and improving survivor neurological outcomes, and reinforces the proper use of tPA for stroke patients.

Tissue Plasminogen Activator, or tPA, should be given within three hours of symptom onset to eligible acute stroke patients. A quick and accurate diagnosis is essential so the drug can be administered appropriately. In the VHA initiative, participating hospitals reduced the time it took from patients' arrival at the hospital to the interpretation of the CT scan from an average of 219 minutes to 115 minutes. The program's guidelines stress the need to move quickly when evaluating and treating stroke patients and to use great care in determining which patients should receive tPA.

Studies from other hospitals published in the March 1 issue of the Journal of the American Medical Association showed that very few patients are getting tPA -- less than 2 percent in one study -- and that treatment protocols were violated in about one third of patients. Those violations can lead to serious complications, symptomatic and fatal hemorrhage and increased mortality rates.

"When used appropriately tPA has proven to be highly effective. But the drug should not be administered outside the three-hour window or if a CT scan reveals bleeding in the brain. Timing and proper administration can mean the difference between life and death, recovery and disability," said Marilyn Rymer, M.D., national chairperson of VHA's Clinical Advantage stroke initiative and medical director of the Stroke Center for Saint Luke's Hospital in Kansas City.

Someone in the United States suffers a stroke every 53 seconds, and strokes take a life every 3 1/2 minutes. Of the more than 700,000 new or recurrent stroke cases diagnosed each year in the U.S., it is estimated that 80 percent could be effectively treated with tPA if proper guidelines are followed.

Participating in VHA's Clinical Advantage stroke initiative were nearly 200 professionals from 40 health care organizations in Indiana, Kentucky, Maryland, North Carolina, Ohio, Tennessee, Virginia and West Virginia. Other regional VHA stroke initiatives are currently underway. VHA's Clinical Advantage programs use evidence-based knowledge and innovative methodologies to quickly raise the level of patient care in VHA health care organizations in key aspects of care. In addition to stroke care, current or planned Clinical Advantage initiatives include the treatment of heart attacks, breast cancer and congestive heart failure, as well as end-of-life care, medication error reduction and patient safety.

Developed by an interdisciplinary team of experts, Clinical Advantage is designed to accelerate learning, produce sustainable results and break down the barriers to change in clinical improvement. Participating organizations come together through educational programs, a series of learning workshops, national conferences or satellite broadcasts to learn to use a rapid improvement methodology to yield fast, measurable results.

During accelerated learning workshops, interdisciplinary teams from participating organizations join nationally and regionally recognized clinical improvement experts to focus on immediate action and benefits. Teams then work with each other and VHA staff to develop and test their plans for implementing change.

"VHA's Clinical Advantage provides health care organizations with the tools, methodologies and ongoing assistance needed to help ensure success in clinical improvement initiatives," Dr. Rymer said, noting that VHA health care organizations can help to dramatically increase the quality of care for patients across America by participating in Clinical Advantage.

Related Link: Journal of the American Medical Association.

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