A qualitative assessment of practices associated with shorter door-to-needle time for thrombolytic therapy in acute ischemic stroke

J Neurosci Nurs. 2011 Dec;43(6):329-36. doi: 10.1097/JNN.0b013e318234e7fb.


Early treatment with intravenous (IV) recombinant tissue plasminogen activator/alteplase (tPA) is associated with improved outcomes for patients with an acute ischemic stroke. Thus, rapid triage and treatment of stroke patients are essential, with a goal of door-to-needle time of no more than 60 minutes. We sought to identify best practices associated with faster treatment among hospitals participating in Get With the Guidelines--Stroke. Qualitative telephone interviews were conducted to elicit strategies being used by these centers to assess, treat, and monitor stroke patients treated with IV tPA. We sequentially carried out these interviews until we no longer identified novel factors. Interviews were conducted with 13 personnel at 7 top-performing U.S. hospitals. With the use of a hermeneutic-phenomenological framework, 5 distinct domains associated with rapid IV tPA delivery were identified. These included (a) communication and teamwork, (b) process, (c) organizational culture, (d) performance monitoring and feedback, and (e) overcoming barriers.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Acute Disease
  • Brain Ischemia / drug therapy*
  • Brain Ischemia / nursing
  • Emergency Medical Services / organization & administration
  • Emergency Medical Services / standards*
  • Emergency Nursing / organization & administration
  • Emergency Nursing / standards
  • Humans
  • Interviews as Topic / methods
  • Nursing Methodology Research
  • Organizational Culture
  • Patient Care Team / organization & administration
  • Patient Care Team / standards
  • Qualitative Research
  • Stroke / drug therapy*
  • Stroke / nursing
  • Thrombolytic Therapy / standards*
  • Time Factors
  • Triage / organization & administration
  • Triage / standards