Dr. Sanford Veider, chairman and medical director of Botsford Hospital Emergency and Trauma Center, served as a principal investigator on a large clinical trial aimed at improving delivery of a time-sensitive, clot-busting drug in stroke patients at Botsford and other community hospitals.
The study, which was funded by the National Institutes of Health and called INSTINCT (for INcreasing Stroke Treatment through INterventional Change Tactics), is the first robust study to show safe, appropriate use of tPA in the community hospital setting. Principal investigator sites included Botsford and other community hospitals across Michigan.
The research effort was coordinated by a multi-disciplinary team from the University of Michigan Health System which offered half the hospitals education and round-the-clock treatment assistance by phone.
By the end of the study, the community hospitals across Michigan that had the U-M experts as the "sixth man" on their teams did better at delivering the drug called tPA to eligible patients than those that didn't.
The findings of the randomized controlled trial are published in Lancet-Neurology. They show that community hospitals like Botsford can indeed improve patients' chances of getting tPA in the first few hours of a stroke, without increased risk of dangerous bleeding.
Data from 22 of the hospitals show that tPA use more than doubled in the 11 hospitals that were randomly chosen to get the extra help, versus a smaller increase in the 11 that didn't. Some hospitals even surpassed national targets for tPA use that large stroke centers don't always reach – a true game-changing performance.
Across the U.S., less than 2 percent of stroke patients receive tPA – when more than 11 percent could – largely because of the time limits on its use and delays in getting patients to a hospital. That's why it's important for community hospitals to offer it.
The study demonstrates that more work needs to be done to expand public access to the only treatment approved by the U.S. FDA to reverse the effects of stroke. While improvement at the target community hospitals that got the education was statistically significant, it was not as large as hoped for. But the findings suggest that relatively low-cost and low-tech interventions can improve local stroke care.
"The results of this study mean that people in Farmington Hills and nearby communities have access to state-of-the-art stroke care at Botsford Hospital, and they'll get it quickly and safely," explains Dr. Vieder. "That's important because when it's a stroke," he adds, "every second counts."
Source: Botsford Hospital press release