Study: Hospitals Often Overestimate Ability to Achieve Door-to-Needle Guideline Goals in Stroke Treatment

July 22, 2015—The American Heart Association (AHA) announced findings from a study showing that hospitals often overestimate their performance—based on “door-to-needle” time—in providing fast delivery of intravenous tissue plasminogen activator (tPA) to stroke patients. Cheryl B. Lin, MD, et al published the study online in the Journal of the American Heart Association.

According to the AHA, responses from a telephone survey of staff at 141 hospitals that treated 48,201 stroke patients in 2009 and 2010 were compared with patients’ data, including the onset of their stroke symptoms, hospital arrival time, treatments, initiation of tPA, and complications from the drug.

All of the hospitals surveyed participated in the AHA’s Get With the Guidelines-Stroke national quality improvement program, which is designed to ensure consistency in timely stroke care. Hospitals were categorized as high-, middle- or low-performing based on the percentage of time they appropriately administered tPA. Guidelines recommend delivering tPA within 60 minutes of the patient’s arrival to the hospital, noted the AHA.

The investigators reported that only 29% of hospital staff accurately identified their door-to-needle time. Additionally, 42% of middle-performing hospitals and 85% of low-performing hospitals overestimated their abilities to quickly administer tPA. Approximately 20% of low-performing hospitals believed their door-to-needle times were above the national average. The study also found that hospitals that overestimated their performance tended to have lower volumes of tPA administration.

A factor affecting the disparity between hospital perception and performance included stroke patient volume. However, hospital size or region did not appear to be a major factor, noted the investigators.

Dr. Lin commented in the AHA announcement, “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 United States.”

In the study, the investigators also advised that these findings indicate the need to routinely use comparative provider performance rates as a key step to improving the quality of acute stroke care.