- Title
- Door-to-needle time for thrombolysis: a secondary analysis of the TIPS cluster randomised controlled trial
- Creator
- Hasnain, Md Golam; Paul, Christine L.; Attia, John R.; Ryan, Annika; Kerr, Erin; D'Este, Catherine; Hall, Alix; Milton, Abul Hasnat; Hubbard, Isobel J.; Levi, Christopher R.
- Relation
- NHMRC.569328 http://purl.org/au-research/grants/nhmrc/569328
- Relation
- BMJ Open Vol. 9, Issue 12, no. e032482
- Publisher Link
- http://dx.doi.org/10.1136/bmjopen-2019-032482
- Publisher
- BMJ Group
- Resource Type
- journal article
- Date
- 2019
- Description
- 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.
- Subject
- intravenous thrombolysis; ischaemic stroke; door to needle; Australia
- Identifier
- http://hdl.handle.net/1959.13/1418264
- Identifier
- uon:37320
- Identifier
- ISSN:2044-6055
- Rights
- © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
- Language
- eng
- Full Text
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