NC West Virginia News

West Virginia University research has found that American Heart Association (AHA) and American Stroke Association (ASA) guidelines are effective in speeding up hospitals’ response times for stroke treatment. These guidelines can be mastered even by members of "ad hoc" medical teams that assemble rapidly.

When a stroke patient arrives at an emergency room, specialists from various hospital departments coordinate a team response. AHA and ASA guidelines set specific limits on the time between the onset of ischemic stroke and subsequent events like arrival at the hospital and delivery of an infusion.

However, experts have questioned whether these best practices help temporary medical teams whose members do not typically collaborate. A Journal of Operations Management paper by WVU John Chambers College of Business and Economics associate professor Bernardo Quiroga and coauthors answers this question using data from over 8,000 patients treated for stroke at a large hospital between 2009 and 2017.

“‘Time is brain’ for stroke victims,” Quiroga explained. “Blocked blood flow to the brain kills almost two million neurons a minute, so your life or ability to walk or talk hinges on how quickly multiple professionals coordinate to restore blood flow."

In 2010, the AHA and ASA launched Target: Stroke, a program identifying best practices in stroke care. Participating hospitals reduced median treatment times from 79 minutes in 2009 to 51 minutes in 2017. The researchers sought to determine if this improvement was driven by adherence to best practices or by clinicians learning through repetition as they handled more cases.

The study found that learning through repetition worked; more strokes treated led to faster responses. For each doubling of cumulative stroke alerts, “door-to-needle time” decreased by 10.2%. Best practices also worked, specifically examining two protocols: the Helsinki Model protocol and the Rapid Administration of TPA protocol.

According to Quiroga’s coauthor Brandon Lee, this demonstrates the efficacy of best practices and shows ad hoc teams learning guidelines long-term. However, Lee emphasized the importance of a hospital’s stroke advisory committee setting targets, evaluating performances, and giving feedback.

Quiroga acknowledged that without similar countermeasures to organizational forgetting, best practices aren’t always sustainable on ad hoc teams due to coordination challenges with independent EMS systems and staff turnover.

Lee added that while ad hoc teams learn more slowly due to fluidity and harder information sharing, they still learn over time.

The research also assessed whether neurologists’ abilities were affected by their recent experiences treating prior patients. Data showed improvement regardless of individual neurologist experience or success rate. Quiroga said this is positive news for overall team performance.