A new study published in Neurology has found that making small changes in quality improvement procedures enabled clinicians at two facilities to use MRI scans to diagnose stroke patients within 60 minutes of hospital arrival, in accordance with national guidelines. Research has shown that early treatment for stroke is associated with better outcomes. The Screening with MRI for Accurate and Rapid stroke Treatment (SMART) study was led by Amie Hsia, MD, medical director of the Comprehensive Stroke Center at MedStar Washington Hospital Center, Washington DC, and senior author of the study. The National Institutes of Health’s National Institute of Neurological Disorders and Stroke (NINDS) also supported the study.
Most hospitals currently rely on CT scans to determine if an individual is eligible for intravenous tPA, the only FDA-approved treatment for ischemic strokes. If the CT scan reveals that the patient is instead undergoing a hemorrhagic stroke, tPA cannot be used as treatment. MedStar Washington Hospital Center and Suburban Hospital in Bethesda, Md, the two facilities involved in the study, regularly use MRI to evaluate their patients. Although MRI may take up to 15 minutes longer than CT scans, the modality can provide subtle details not visible in a CT scan.
As part of the study, the facilities evaluated existing procedures and implemented process improvements to shorten time to treatment. At MedStar Washington Hospital Center, the MRI screening form was simplified to three questions, and at Suburban Hospital, tPA was placed in the MRI suite so eligible patients could receive medication immediately following their scan. As a result, door to treatment time was reduced from 93 to 55 minutes, or by 40%. Over a 2-year period, the percentage of patients treated within 60 minutes increased from 13% to 61.5%.
“A number of the changes that Dr. Hsia’s team assessed were not specific for MRI scans, but were related to general procedures of getting patients ready for imaging as quickly as possible. This suggests that these findings are relevant even in hospitals that do not have emergency access to MRI scanners,” said Walter Koroshetz, MD, acting director of NINDS. “We will persist in evaluating best practices for acute stroke care to ensure that the greatest number of patients receive treatment as early as possible following stroke.”
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