Direct stroke unit admission of intravenous tissue plasminogen activator

Safety, clinical outcome, and hospital cost savings

Anne Alexandrov, Kisha C. Coleman, Paola Palazzo, Reza Bavarsad Shahripour, Andrei Alexandrov

Research output: Contribution to journalArticle

Abstract

Background: In the USA, stable intravenous tissue plasminogen activator (IV tPA) patients have traditionally been cared for in an intensive care unit (ICU). We examined the safety of using an acuity-adaptable stroke unit (SU) to manage IV tPA patients. Methods: We conducted an observational study of consecutive patients admitted to our acuity-adaptable SU over the first 3 years of operation. Safety was assessed by symptomatic intracerebral hemorrhage (sICH) rates, systemic hemorrhage (SH) rates, tPA-related deaths, and transfers from SU to ICU; cost savings and length of stay (LOS) were determined. Results: We admitted 333 IV tPA patients, of which 302 were admitted directly to the SU. A total of 31 (10%) patients had concurrent systemic hemodynamic or pulmonary compromise warranting direct ICU admission. There were no differences in admission National Institutes of Health Stroke Scale scores between SU and ICU patients (9.0 versus 9.5, respectively). Overall sICH rate was 3.3% (n = 10) and SH rate was 2.9 (n = 9), with no difference between SU and ICU patients. No tPA-related deaths occurred, and no SU patients required transfer to the ICU. Estimated hospital cost savings were US$362,400 for 'avoided' ICU days, and hospital LOS decreased significantly (p = 0.001) from 9.8 ± 15.6 days (median 5) in year 1, to 5.2 ± 4.8 days (median 3) by year 3. Conclusions: IV tPA patients may be safely cared for in a SU when nurses undergo extensive education to ensure clinical competence. Use of the ICU solely for monitoring may constitute significant overuse of system resources at an expense that is not associated with additional safety benefit.

Original languageEnglish (US)
Pages (from-to)304-309
Number of pages6
JournalTherapeutic Advances in Neurological Disorders
Volume9
Issue number4
DOIs
StatePublished - Jul 1 2016

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Cost Savings
Hospital Costs
Tissue Plasminogen Activator
Intensive Care Units
Stroke
Safety
Length of Stay
Cerebral Hemorrhage
Hemorrhage
Patient Transfer
Clinical Competence
National Institutes of Health (U.S.)
Observational Studies
Hemodynamics
Nurses
Education
Lung

All Science Journal Classification (ASJC) codes

  • Pharmacology
  • Neurology
  • Clinical Neurology

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Direct stroke unit admission of intravenous tissue plasminogen activator : Safety, clinical outcome, and hospital cost savings. / Alexandrov, Anne; Coleman, Kisha C.; Palazzo, Paola; Shahripour, Reza Bavarsad; Alexandrov, Andrei.

In: Therapeutic Advances in Neurological Disorders, Vol. 9, No. 4, 01.07.2016, p. 304-309.

Research output: Contribution to journalArticle

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