To examine the progressive quality benchmarks for acute ischemic stroke (AIS) at an academic comprehensive stroke center (CSC).

Ongoing quality improvement is essential for better outcomes and healthcare cost control. 

We retrospectively analyzed consecutive patients with AIS at UC Irvine Medical Center from 2013 to  2018. Demographics and clinical data were collected from the Get-With-The-Guideline (GWTG)-Stroke registry and electronic medical records. Patients were stratified into 3 time periods according to their admission dates: 2013 to 2014; 2015 to 2016; and 2017 to 2018. Quality benchmarks for AIS, including door-to-needle (DTN) times, rates of receiving IV tPA and/or endovascular thrombectomy (EVT), and outcomes at hospital discharge were analyzed to identify trends of quality improvement in the last 6 years.

A total of 1369 patients were included in the study; 398 (29%) patients received acute reperfusion therapy, with 231 (17%) receiving IV tPA, 97 (7%) receiving both IV tPA and EVT, 70 (5%) receiving EVT only. There was no significant difference in baseline characteristics of the patients during the 3 time periods.  IV tPA rates were 20% in 2013-2014, 30% in 2015-2016, and 22% in 2017-2018 (p=0.0005). The EVT rates in 2017-2018 (15% vs. 9%; OR: 1.77; 95% CI: 1.16 - 2.68; p = 0.008) and 2015-2016 (14% vs. 9%; OR: 1.70; 95% CI: 1.11 - 2.59; p = 0.01) were significantly higher than in 2013-2014. There were significant ongoing improvements in median DTN times, with 57 minutes in 2013-2014, 45 minutes in 2015-2016, and 39 minutes in 2017-2018. Among patients receiving IV tPA, significantly more patients had favorable outcomes (mRS score 0-3) at hospital discharge in 2015-2016 (67% vs. 42%; OR: 2.80; 95% CI: 1.46 – 5.40; p= 0.002) than in 2013-2014. 

We demonstrate ongoing improvement in rates of IV tPA, EVT and DTN times for IV tPA in patients with AIS.