Reduction of In-hospital Delays in Stroke Thrombolysis: SITS-WATCH

Study Overview
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Brief Summary
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In patients with acute ischemic stroke: the sooner the thrombolysis treatment is administered after symptom onset - the better the outcome. This delay can be dissected into onset-to-door time and door-to-needle time (DNT). SITS-WATCH aims to reduce median DNT in participating centres.

Detailed Description
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In patients with acute ischemic stroke: the sooner the thrombolysis treatment is administered after symptom onset - the better the outcome. This delay can be dissected into onset-to-door time and door-to-needle time (DNT). Of the two, DNT can be directly influenced within the hospital by stream-lining of acute stroke care. The aim of our study is to reduce in-hospital delays (DNT) in self-selecting centers recruiting patients into the the Safe Implementation of Treatments in Stroke-International Stroke Thrombolysis Register (SITS-ISTR) , comprising currently more than 80 000 patients from 1338 centers. Current median of DNT in all SITS centers is 65 minutes (compared with 20 minutes in Helsinki Univer-sity Central Hospital). An itemized detailed questionnaire, including all factors known to influence DNT, has been sent to all SITS centers to identify the reasons for long in-hospital delays. Based on the replies, we have prepared a list of interventions that can be considered by individual SITS centers in order to reduce DNT with interventions that are in line with national legislation.

Official Title
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Reduction of In-hospital Delays in Stroke Thrombolysis: SITS-WATCH

Conditions
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Stroke

Intervention / Treatment
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* Other: Reduction of DTN


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All consecutive patients with acute ischemic stroke registered in SITS registry. Exclusion Criteria: Centers not inputing patient data into SITS registry. Patients with missing DNT data.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Intervention group (SITS-WATCH centers)<br>15-item list of suggested interventions aiming to reduce DNT sent to SITS-WATCH centers. | Other: Reduction of DTN<br>* 15-item list of suggested interventions aiming to reduce DNT sent to SITS-WATCH centers.<br>|
| No Intervention: Control group (non SITS-WATCH centers in SITS registry)<br>Centres that do not use 15-item list of suggested interventions aiming to reduce DNT. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Absolute DNT reduction of at least 20 minutes or at least 20% change in SITS-WATCH centers that completed the whole study period | DNT will be evaluated at regular intervals (twice a year). | January 2013-December 2014 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Significantly larger reduction of DNT in SITS-WATCH centers compared with non-SITS-WATCH centers in SITS. | Proportion of centers with median DNT below 40 minutes. At least 3 new interventions implemented. Percentage of implemented interventions. | 2014-2015 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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inhospital delays, door-to-needle time, thrombolysis, acute ischemic stroke, SITS, SITS-WATCH, stroke registry