Clinical audit of stroke thrombolysis in Wellington, New Zealand: disparity between in-hours and out-of-hours treatment time.

ABSTRACT

AIMS: To report on the safety and efficiency of a comprehensive stroke thrombolysis service and look for evidence of disparity between in-hours and out-of-hours treatment times. METHOD: Clinical audit of patients treated with tissue plasminogen activator, alteplase (rt-PA) for stroke at Wellington Hospital between 1 November 2009 and 31 October 2010. RESULTS: Thirty-one patients were treated with rt-PA. All were treated within agreed clinical eligibility criteria. The median NIHSS score pre-treatment was 10; post treatment 5. Two patients died, both from intracranial haemorrhage. Overall the average time to treatment from symptom onset was 168 minutes. Those treated out-of-hours had an additional delay of 33 minutes compared to in-hours treatment (p=0.03). CONCLUSIONS: Patients admitted out-of-hours had significantly longer delays to rt-PA treatment. Those planning Stroke Services should ensure this source of inequity is addressed within their localities.