New DTN protocol renders MRI effective for screening stroke patients

Thanks to reduced door-to-needle (DTN) time, MRI was proven to be an effective screening tool for stroke victims before they receive acute treatment, according to findings published in Neurology. CT scans are primarily used for such screenings, because MRI take too long to complete, but the Screening with MRI for Accurate and Rapid Stroke Treatment (SMART) Study showed that DTN times of 60 minutes or less can regularly be achieved with MRI if some procedural changes are followed.

Amie Hsia, MD, and colleagues conducted the SMART Study by making specific quality improvement (QI) changes at two hospitals—MedStar Washington Hospital Center (Washington, DC) and Suburban Hospital (Bethesda, Md.)—where MRI was already being used for screening acute ischemic stroke (AIS) patients. From January 2012 to December 2013, 135 total patients were treated with IV tissue plasminogen activator (IV tPA) following a stroke and screened with MRI. The study looked at the DTN time, door-to-MRI start time, MRI-to-needle time and other factors for these patients before the QI changes were implemented and after, comparing the data to see if the changes worked.

The QI changes were determined by identifying inefficiencies in the DTN workflow. Changes included simplifying forms, defining responsibilities of emergency department personnel and reducing the time spent transferring patients around the hospital. No changes were made to actual MRI acquisition protocol.

The numbers showed that the SMART Study’s proposed changes were clearly successful. Median DTN time went from 93 minutes to 55 minutes after the changes were made. The number of patients with a DTN time less than 60 minutes went from 13% to 61.6%. Median door-to-MRI time stands out the most, going from 49 minutes to 24 minutes.

“Our study demonstrates that rapid and efficient delivery of IV tPA within national benchmark times is feasible and practical using MRI as the routine screening modality,” Hsia et al wrote.

Every hospital is unique and will have problems specific to its situation, but the authors explain that all of the changes they implemented could be duplicated in other hospitals with inefficiencies similar to the ones they encountered.

“The processes we have implemented and illustrated are applicable to other centers performing or considering screening MRI for acute stroke treatment evaluation,” Hsia et al wrote.

The study was supported by the National Institutes of Health’s National Institute of Neurological Disorders and Stroke.