Objective:

To evaluate the impact of innovative guidelines designed to reduce tPA/tNK refusal rates among minority populations at King County Hospital (KCHC), and to assess their effectiveness in improving treatment uptake and patient outcomes.

Background:

Despite the proven efficacy of thrombolytic therapies in acute ischemic stroke, in 2016, the thrombolysis refusal rate at KCHC was 13.3%, compared to the national average, 8.6%.  We have developed and implemented guidelines with innovative use of CTP images to decrease thrombolysis refusal rates.

Design/Methods:

From 2016 to 2024 retrospective chart review was performed on patients who refused thrombolysis cs including age, sex, education, and reason for refusal, were obtained. 

We developed patient education, provider training, and systemic changes to improve access to care.

A standardized approach in verbal assent of risks and benefits of thrombolysis was implemented with utilization of CTP as a visual to demonstrate core and penumbra volumes to the patients.  Outcomes measured are IV thrombolysis refusal rates.

Results:

From 2016 to 2024, a total of 40 patients refused IV thrombolytic medication with 5/40 (12.5%), 3/40 (7.5%) due to side effects, and religious reasons, respectively.  34/40 (85%) had less than a college education which denotes 5.6 OR than those who refuse IV thrombolysis with a college education or higher.  25/40 (62.5%) were women, 23/40 (57.5%) were older than 60 age.  The national refusal rate continued to be 8.7% in 2016 to 6.3% in 2024.  With our intervention performed, the refusal rate at KCH dropped from 13.3% in 2016 to 5.3% in 2023 to 2% in 2024.  Meanwhile, our “access to treat” measure, arrival within 3.5 hours and treatment within 4.5 hours remains 100%.   

Conclusions:

Standardization of verbal assent with innovative utilization of to reduced tPA/tNK refusal rates among minority communities highlight the importance of integrating community engagement, and systemic reform to overcome barriers to acute stroke treatment.