IV Alteplase Administration Care Improves With Maryland Stroke Coalition Program

The Maryland Stroke Coalition’s (MSC) coordinated cooperative approach to performance improvement was associated with increased intravenous (IV) alteplase administration rates and decreased median door to IV alteplase administration times, according to study data presented at the International Stroke Conference 2020

The MSC comprises major stakeholders including physicians, nurses, and regulatory officers from the Maryland Stroke Center Consortium and the Stroke Quality Improvement Committee of the Maryland Institute for Emergency Medical Services Systems Health Care Facilities. 

Beginning in 2012, the MSC convened every two months to discuss challenges associated with  IV alteplase administration and treatment delays. From these meetings, AHA Target Phase III was implemented. This included educational presentations, academic centers sharing protocols, rapid implementation of new clinical practice guidelines, state mandated metrics, and sharing of state aggregate data.

From 2012 to 2018, the most significant results of the implementation of AHA Target Phase III were as follows:

• 47% increase in patients who were administered IV alteplase (CY 2012 (n=528) to CY 2018 (n=1133)
• Door to IV alteplase time was decreased from a median 75 minutes to 28 minutes
• Percentage of patients who received IV alteplase <60 minutes increased by 50%
• Percentage of patients who received IV alteplase <45 minutes increased by 22.7%.

“The MSC’s leadership plan is to perform a statewide cultural assessment to identify barriers and facilitators to assist stroke centers increase the percentage of patients who receive alteplase < 45 minutes and to
improve door in-door out times for mechanical thrombectomy patients,” concluded the researchers in their study’s abstract. —Edan Stanley