Decision-making support using a standardized script and visual decision aid to reduce door-to-needle time in stroke

Abstract

Background and Purpose: Rapid administration of intravenous recombinant tissue plasminogen activator (IV tPA) is an effective way to enhance thrombolytic efficacy in stroke patients. The process of decision-making by patients or their families may cause a delay in treatment. We investigated how a protocol using decision-making support (DMS) for patients and their families could reduce door-to-needle time in acute stroke. Methods: We implemented a DMS protocol using a standardized script and visual decision aid for explanations to patients and their families. Reasons for delay were identified in cases with door-to-needle time >40 min. We compared door-to-needle time and reasons for treatment delay before (January 2007 to December 2009) and after (January 2010 to December 2012) implementation of the DMS protocol. 2 Results: After the implementation of DMS protocol, median door-to-needle time was reduced from 46 min to 40 min (p=0.001). The proportion of patients with door-to-needle time ≤ 40 min was greater after the implementation (64/118 [54.2%] vs. 40/111 [36.0%], p=0.006). The proportion of cases with delay due to waiting for informed consent was significantly reduced from 32.4 % to 14.8% (p=0.024). Multivariable logistic regression analysis showed that the implementation of the DMS protocol was independently associated with door to-needle time ≤40 min (adjusted odds ratio 2.13, 95% confidence interval 1.23 3.67). Conclusion: Decision making support for the patient or family’s decision using standardized scripts and visual aids was helpful in reducing door-to-needle time. More widespread implementation of this approach is warranted because it is simpleand can be easily implemented.