Hospital surveillance of acute stroke treatment in Michigan.

INTRODUCTION: Modern management of acute stroke, including the use of tissue plasminogen activator (t-PA), requires hospitals to be better prepared for rapid diagnosis and treatment. METHODS: Surveillance of practice of acute stroke treatment by Michigan hospitals was performed in 1998. We determined variation in hospital preparedness for treatment by number of emergency department visits. Factors associated with hospital use of t-PA were analyzed using logistic regression. RESULTS: Surveys were returned by 97 (55%) hospitals. Hospitals with a greater number of emergency department visits were significantly more likely to have a clinical pathway, to have given t-PA, and to be better prepared for stroke treatment. After multivariate analysis, greater number of stroke patients per year (P < .001) and availability of skilled intensive care department staff (P = .056) were associated with hospital t-PA use. CONCLUSIONS: Specific hospital characteristics are associated with t-PA use. Consideration of these may be used to devise new strategies for improved delivery of acute stroke treatment.