Factors associated with delays in administering intravenous rt-PA in Stroke Fast Track patients in Phon Hospital, Khon Kaen
Keywords:
Acute Ischemic Stroke, rt-PA, Door-to-Needle Time, District HospitalAbstract
This retrospective cohort study was conducted in Phon Hospital, Khon Kaen, from November 2021 and August 2025. We collected data from patient records and acute ischemic stroke database. This study aims to investigate factors associated with delayed intravenous rt-PA administration in patients with acute ischemic stroke. Results showed that factors associated with delayed intravenous rt-PA administration in patients with acute ischemic stroke were Door to CT scan time > 25 minutes with an AOR = 3.73(95% CI: 1.27 - 10.97, P = 0.017), transport by EMS with an AOR = 2.68(95% CI: 1.18 - 6.07, P = 0.018), and 58.2% of patients received intravenous rt-PA with a delay (DNT > 60 minutes). These results indicate that improvements to DNT at Phon Hospital should focus on optimizing the Stroke Fast Track workflow. The focus should be on reducing Door to CT scan time, which should involve establishing agreements such as allowing triage nurses to order CT scans according to criteria or protocol for directly transfer patients to the CT scan room to eliminate steps. Including the EMS Fast Track system requires improvement by reviewing the handover process to eliminate redundancies and developing a pre-arrival notification system to ensure patients transported via EMS truly benefit from the emergency service.
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