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August 14, 2013

Helsinki model cut stroke thrombolysis delays to 25 minutes in Melbourne in only 4 months

Atte Meretoja, MD, PhD, MScStrokeMed, Louise Weir, RN, NP, GradCertStrokeMgt, MANP, Melissa Ugalde, RN, GradCertNeurosci, Nawaf Yassi, MBBS, BSc(Med), FRACP, Bernard Yan, MBBS, FRACP, Peter Hand, MD, FRACP, Melinda Truesdale, MBBS, GradDipHSM, FACEM, Stephen M. Davis, MD, FRACP, and Bruce C.V. Campbell, MBBS, BMedSc, PhD, FRACPAuthors Info & Affiliations
September 17, 2013 issue
81 (12) 1071-1076
https://doi.org/10.1212/WNL.0b013e3182a4a4d2
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Abstract

Objective:

To test the transferability of the Helsinki stroke thrombolysis model that achieved a median 20-minute door-to-needle time (DNT) to an Australian health care setting.

Methods:

The existing “code stroke” model at the Royal Melbourne Hospital was evaluated and restructured to include key components of the Helsinki model: 1) ambulance prenotification with patient details alerting the stroke team to meet the patient on arrival; 2) patients transferred directly from triage onto the CT table on the ambulance stretcher; and 3) tissue plasminogen activator (tPA) delivered in CT immediately after imaging. We analyzed our prospective, consecutive tPA registry for effects of these protocol changes on our DNT after implementation during business hours (8 am to 5 pm Monday–Friday) from May 2012.

Results:

There were 48 patients treated with tPA in the 8 months after the protocol change. Compared with 85 patients treated in 2011, the median (interquartile range) DNT was reduced from 61 (43–75) minutes to 46 (24–79) minutes (p = 0.040). All of the effect came from the change in the in-hours DNT, down from 43 (33–59) to 25 (19–48) minutes (p = 0.009), whereas the out-of-hours delays remain unchanged, from 67 (55–82) to 62 (44–95) minutes (p = 0.835).

Conclusion:

We demonstrated rapid transferability of an optimized tPA protocol to a different health care setting. With the cooperation of ambulance, emergency, and stroke teams, we succeeded in the absence of a dedicated neurologic emergency department or electronic patient records, which are features of the Finnish system. The next challenge is providing the same service out-of-hours.

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Information & Authors

Information

Published In

Neurology®
Volume 81 • Number 12 • September 17, 2013
Pages: 1071-1076
PubMed: 23946303

Copyright

© 2013 American Academy of Neurology.

Publication History

Received: February 18, 2013
Accepted: June 17, 2013
Published online: August 14, 2013
Published in print: September 17, 2013

Permissions

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Disclosure

M. Meretoja, L. Weir, M. Ugalde, and N. Yassi report no disclosures. B. Yan has received speaker's honoraria from Boehringer Ingelheim. P. Hand and M. Truesdale report no disclosures. S. Davis has received speaker's honoraria from Sanofi, Boehringer Ingelheim, Ever Neuro Pharma, and Allergan and has consulted for Boehringer Ingelheim, Ever Neuro Pharma, and Allergan. B. Campbell has received speaker's honoraria from Novartis and Boehringer Ingelheim and has consulted for Lundbeck. Go to Neurology.org for full disclosures.

Study Funding

Supported by the National Health and Medical Research Council of Australia (NHMRC) Centre for Research Excellence grant 1001216. The authors received additional support from Finnish Medical, Biomedicum Helsinki, and Sigrid Jusélius Foundations (A.M.), University of Melbourne, and Neurosciences Victoria (N.Y.), NHMRC Early Career Fellowship 1035688, Heart Foundation of Australia, National Stroke Foundation, and Cardiovascular Lipid Australia (B.C.V.C), and The Royal Melbourne Hospital Neurosciences Foundation (N.Y., B.C.V.C).

Authors

Affiliations & Disclosures

Atte Meretoja, MD, PhD, MScStrokeMed
From the Departments of Neurology and Medicine (A.M., L.W., M.U., N.Y., B.Y., P.H., S.M.D., B.C.V.C), Nursing (L.W.), and Emergency Department (M.T.), The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; and Department of Neurology (A.M.), Helsinki University Central Hospital, Finland.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
International Journal of Stroke, editorial board member, 2013-
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
(1) Sigrid Juselius Foundation, (2) Biomedicum Helsinki Foundation, (3) Finnish Medical Foundation
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Louise Weir, RN, NP, GradCertStrokeMgt, MANP
From the Departments of Neurology and Medicine (A.M., L.W., M.U., N.Y., B.Y., P.H., S.M.D., B.C.V.C), Nursing (L.W.), and Emergency Department (M.T.), The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; and Department of Neurology (A.M.), Helsinki University Central Hospital, Finland.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Melissa Ugalde, RN, GradCertNeurosci
From the Departments of Neurology and Medicine (A.M., L.W., M.U., N.Y., B.Y., P.H., S.M.D., B.C.V.C), Nursing (L.W.), and Emergency Department (M.T.), The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; and Department of Neurology (A.M.), Helsinki University Central Hospital, Finland.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Nawaf Yassi, MBBS, BSc(Med), FRACP
From the Departments of Neurology and Medicine (A.M., L.W., M.U., N.Y., B.Y., P.H., S.M.D., B.C.V.C), Nursing (L.W.), and Emergency Department (M.T.), The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; and Department of Neurology (A.M.), Helsinki University Central Hospital, Finland.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Bernard Yan, MBBS, FRACP
From the Departments of Neurology and Medicine (A.M., L.W., M.U., N.Y., B.Y., P.H., S.M.D., B.C.V.C), Nursing (L.W.), and Emergency Department (M.T.), The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; and Department of Neurology (A.M.), Helsinki University Central Hospital, Finland.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
Speaker's honoraria from Boehringer Ingelheim
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Peter Hand, MD, FRACP
From the Departments of Neurology and Medicine (A.M., L.W., M.U., N.Y., B.Y., P.H., S.M.D., B.C.V.C), Nursing (L.W.), and Emergency Department (M.T.), The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; and Department of Neurology (A.M.), Helsinki University Central Hospital, Finland.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Melinda Truesdale, MBBS, GradDipHSM, FACEM
From the Departments of Neurology and Medicine (A.M., L.W., M.U., N.Y., B.Y., P.H., S.M.D., B.C.V.C), Nursing (L.W.), and Emergency Department (M.T.), The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; and Department of Neurology (A.M.), Helsinki University Central Hospital, Finland.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Stephen M. Davis, MD, FRACP
From the Departments of Neurology and Medicine (A.M., L.W., M.U., N.Y., B.Y., P.H., S.M.D., B.C.V.C), Nursing (L.W.), and Emergency Department (M.T.), The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; and Department of Neurology (A.M.), Helsinki University Central Hospital, Finland.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
(1) Stroke - Section Editor, Clinical Controversies (American Heart Association) (2) Cerebrovascular Diseases (Karger), Associate Editor since 2008 (3) Journal of Clinical Neuroscience (Elsevier) (4)International Journal of Stroke (International Stroke Society - Blackwell) (5)Journal of Neuroimaging (Sage Science Press)
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
Boehringer Ingelheim Allergan EVER Pharma
Speakers' Bureaus:
1.
Boehringer Ingelheim Sanofi-Aventis Allergan EVER Pharma
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
National Health and Medical Research Council of Australia
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Bruce C.V. Campbell, MBBS, BMedSc, PhD, FRACP
From the Departments of Neurology and Medicine (A.M., L.W., M.U., N.Y., B.Y., P.H., S.M.D., B.C.V.C), Nursing (L.W.), and Emergency Department (M.T.), The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; and Department of Neurology (A.M.), Helsinki University Central Hospital, Finland.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
Acted as consultant for Lundbeck on DIAS3 Asia-Pacific recruitment panel
Speakers' Bureaus:
1.
Received speaker's honoraria from Novartis, Boehringer Ingelheim for educational symposia
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NHMRC Early Career Fellowship 1035688 2012-2015
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
Heart Foundation of Australia, National Stroke Foundation, and Cardiovascular Lipid Australia
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author

Notes

Correspondence to Dr. Meretoja: [email protected]
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

Author Contributions

Dr. Meretoja conceived the study, drafted the manuscript, and performed the statistical analyses. Ms. Weir, Dr. Truesdale, and Dr. Campbell coordinated the clinical practice change. Dr. Davis supervised and coordinated the study and obtained study funding. All authors acquired the data, analyzed and interpreted the data, and edited the manuscript for intellectual content.

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