Door-to-needle time for thrombolysis: a secondary analysis of the TIPS cluster randomised controlled trial
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 t...
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BMJ Publishing Group
2019-12-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/9/12/e032482.full |
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| author | Alix Hall Md Golam Hasnain Christine L Paul John R Attia Annika Ryan Erin Kerr Catherine D'Este Abul Hasnat Milton Isobel J Hubbard Christopher R Levi |
| author_facet | Alix Hall Md Golam Hasnain Christine L Paul John R Attia Annika Ryan Erin Kerr Catherine D'Este Abul Hasnat Milton Isobel J Hubbard Christopher R Levi |
| author_sort | Alix Hall |
| collection | DOAJ |
| 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. |
| format | Article |
| id | doaj-art-cb9df07600ae4dab8a36f09e45246969 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2019-12-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-cb9df07600ae4dab8a36f09e452469692024-12-01T12:20:09ZengBMJ Publishing GroupBMJ Open2044-60552019-12-0191210.1136/bmjopen-2019-032482Door-to-needle time for thrombolysis: a secondary analysis of the TIPS cluster randomised controlled trialAlix Hall0Md Golam Hasnain1Christine L Paul2John R Attia3Annika Ryan4Erin Kerr5Catherine D'Este6Abul Hasnat Milton7Isobel J Hubbard8Christopher R Levi9Population Health, Hunter New England Local Health District, Wallsend, New South Wales, AustraliaSchool of Medicine and Public Health (SMPH), Faculty of Health and Medicine, University of Newcastle (UoN), Callaghan, New South Wales, Australia6 School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, AustraliaSchool of Medicine and Public Health (SMPH), Faculty of Health and Medicine, University of Newcastle (UoN), Callaghan, New South Wales, AustraliaSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, AustraliaJohn Hunter Hospital, Department of Neurology, New Lambton Heights, New South Wales, AustraliaSchool of Medicine and Public Health (SMPH), Faculty of Health and Medicine, University of Newcastle (UoN), Callaghan, New South Wales, AustraliaEpidemiology Resource Centre, Dhaka, Dhaka, BangladeshSchool of Medicine and Public Health (SMPH), Faculty of Health and Medicine, University of Newcastle (UoN), Callaghan, New South Wales, AustraliaDepartment of Neurology, John Hunter Hospital, Newcastle, New South Wales, AustraliaObjective 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.https://bmjopen.bmj.com/content/9/12/e032482.full |
| spellingShingle | Alix Hall Md Golam Hasnain Christine L Paul John R Attia Annika Ryan Erin Kerr Catherine D'Este Abul Hasnat Milton Isobel J Hubbard Christopher R Levi Door-to-needle time for thrombolysis: a secondary analysis of the TIPS cluster randomised controlled trial BMJ Open |
| title | Door-to-needle time for thrombolysis: a secondary analysis of the TIPS cluster randomised controlled trial |
| title_full | Door-to-needle time for thrombolysis: a secondary analysis of the TIPS cluster randomised controlled trial |
| title_fullStr | Door-to-needle time for thrombolysis: a secondary analysis of the TIPS cluster randomised controlled trial |
| title_full_unstemmed | Door-to-needle time for thrombolysis: a secondary analysis of the TIPS cluster randomised controlled trial |
| title_short | Door-to-needle time for thrombolysis: a secondary analysis of the TIPS cluster randomised controlled trial |
| title_sort | door to needle time for thrombolysis a secondary analysis of the tips cluster randomised controlled trial |
| url | https://bmjopen.bmj.com/content/9/12/e032482.full |
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