MedicalResearch.com Interview with:
Amie W. Hsia, MD
Medical Director, Comprehensive Stroke Center
MedStar Washington Hospital Center
NIH Stroke Program at MWHC
Associate Professor, Neurology
Georgetown University Washington, DC 20010
Medical Research: What is the background for this study? What are the main findings?
Dr. Hsia: Acute stroke is a common presenting problem in the emergency department. We know that “time is brain” and that for patients experiencing an ischemic or “blockage” type of stroke, the most common type, the sooner we can administer tPA, a clot-busting medication and the only FDA-approved medication to treat acute stroke, the better chance for a good outcome. Therefore, there is a goal national benchmark time of administering the drug to appropriate acute stroke patients within 60 minutes of their arrival to the emergency department. There are many steps that are necessary in the evaluation of an acute stroke patient in the emergency department before tPA can be given. This includes a brain scan to make sure a patient is not having the less common bleeding type of stroke. A CT or “CAT” scan is the typical type of brain scan that is performed in emergency departments across the country and the world to screen a patient before giving tPA. The primary purpose of the CT scan is to exclude bleeding; it is difficult to visualize an early stroke on CT. Though an MRI can give more complete information including showing the stroke as it is happening in these first few hours and though most hospitals have an MRI scanner, an MRI takes longer to perform and has not traditionally been used in an emergency setting.
At the two hospitals included in this study, MedStar Washington Hospital Center in D.C. and Suburban Hospital in Maryland, we are fortunate to serve as the sites for the NINDS intramural stroke clinical research program and use MRI routinely to screen acute stroke patients to learn more about stroke and develop new treatments for stroke. It is upon this foundation that we performed independent hospital-wide quality improvement initiatives engaging multidisciplinary committees with leadership from all the departments involved in the care of the acute stroke patient in that critical first 60 minutes. Inspired by our colleagues at Washington University in St. Louis led by Dr. Andria Ford who used similar methods in reducing treatment times with CT screening, we used lean manufacturing principles to streamline our processes that include MRI screening and dramatically reduced our treatment times from a baseline of 93 minutes down to 55 minutes while still maintaining safety. Through these efficiency improvements, we were able to achieve a 4-fold increase in the percentage of stroke patients treated with tPA within 60 minutes.
Medical Research: What should clinicians and patients take away from your report?
Dr. Hsia: Our report can serve to dispel the myth or misconception that routinely screening with MRI and treating acute stroke patients in under 60 minutes cannot be done. We have clearly demonstrated that this can be done consistently and safely. Through our publication, we aim to share with the medical community very practical details including flowchart diagrams and a copy of the simplified MRI screening form that we now use in practice to serve as a reference for other hospital providers interested in applying similar changes.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Hsia: Our study can really open the doors to more widespread use of this available MRI technology, not only to screen acute stroke patients prior to standard tPA treatment, but also to continue to leverage this technology as we look to identify other new treatments for stroke. Having the more comprehensive information provided by an MRI compared to a CT can serve as a critical tool to guide treatments that can be delivered both quickly and safely
MedicalResearch.com Interview with: Amie W. Hsia, MD (2015). Hospital System Efficiently Uses MRI To Screen For Stroke and Shorten Treatment Window MedicalResearch.com