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Door-to-needle time for thrombolysis: a secondary analysis of the TIPS cluster randomised controlled trial.


ABSTRACT: OBJECTIVE:The current study aimed to evaluate the effects of a multi-component in-hospital intervention on the door-to-needle time for intravenous thrombolysis in acute ischaemic stroke. DESIGN:This study was a post hoc analysis of door-to-needle time data from a cluster-randomised controlled trial testing an intervention to boost intravenous thrombolysis implementation. SETTING:The study was conducted among 20 hospitals from three Australian states. PARTICIPANT:Eligible hospitals had a Stroke Care Unit or staffing equivalent to a stroke physician and a nurse, and were in the early stages of implementing thrombolysis. INTERVENTION:The intervention was multifaceted and developed using the behaviour change wheel and informed by breakthrough collaborative methodology using components of the health behaviour change wheel. PRIMARY AND SECONDARY OUTCOME MEASURES:The primary outcome for this analysis was door-to-needle time for thrombolysis and secondary outcome was the proportion of patients received thrombolysis within 60?min of hospital arrival. RESULTS:The intervention versus control difference in the door-to-needle times was non-significant overall nor significant by hospital classification. To provide additional context for the findings, we also evaluated the results within intervention and control hospitals. During the active-intervention period, the intervention hospitals showed a significant decrease in the door-to-needle time of 9.25?min (95%?CI: -16.93 to 1.57), but during the post-intervention period, the result was not significant. During the active intervention period, control hospitals also showed a significant decrease in the door-to-needle time of 5.26?min (95%?CI: -8.37 to -2.14) and during the post-intervention period, this trend continued with a decrease of 12.13?min (95%?CI: -17.44 to 6.81). CONCLUSION:Across these primary stroke care centres in Australia, a secular trend towards shorter door-to-needle times across both intervention and control hospitals was evident, however the TIPS (Thrombolysis ImPlementation in Stroke) intervention showed no overall effect on door-to-needle times in the randomised comparison. TRIAL REGISTRATION NUMBER:Trial Registration-URL: http://www.anzctr.org.au/ Unique Identifier: ACTRN 12613000939796.

SUBMITTER: Hasnain MG 

PROVIDER: S-EPMC6924711 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Door-to-needle time for thrombolysis: a secondary analysis of the TIPS cluster randomised controlled trial.

Hasnain Md Golam MG   Paul Christine L CL   Attia John R JR   Ryan Annika A   Kerr Erin E   D'Este Catherine C   Hall Alix A   Milton Abul Hasnat AH   Hubbard Isobel J IJ   Levi Christopher R CR  

BMJ open 20191215 12


<h4>Objective</h4>The current study aimed to evaluate the effects of a multi-component in-hospital intervention on the door-to-needle time for intravenous thrombolysis in acute ischaemic stroke.<h4>Design</h4>This study was a post hoc analysis of door-to-needle time data from a cluster-randomised controlled trial testing an intervention to boost intravenous thrombolysis implementation.<h4>Setting</h4>The study was conducted among 20 hospitals from three Australian states.<h4>Participant</h4>Elig  ...[more]

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