Implementation of an institution-wide acute stroke algorithm: Improving stroke quality metrics.

Autor:	Zuckerman SL; Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, USA., Magarik JA; Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, USA., Espaillat KB; Vanderbilt Comprehensive Stroke Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA., Ganesh Kumar N; Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, USA., Bhatia R; Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, USA., Dewan MC; Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, USA., Morone PJ; Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, USA., Hermann LD; Department of Neurology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA., O'Duffy AE; Department of Neurology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA., Riebau DA; Department of Neurology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA., Kirshner HS; Department of Neurology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA., Mocco J; Department of Neurosurgery, Mt. Sinai School of Medicine, New York, USA.
Jazyk:	angličtina
Zdroj:	Surgical neurology international [Surg Neurol Int] 2016 Dec 21; Vol. 7 (Suppl 41), pp. S1041-S1048. Date of Electronic Publication: 2016 Dec 21 (Print Publication: 2016).
DOI:	10.4103/2152-7806.196366
Abstrakt:	Background: In May 2012, an updated stroke algorithm was implemented at Vanderbilt University Medical Center. The current study objectives were to: (1) describe the process of implementing a new stroke algorithm and (2) compare pre- and post-algorithm quality improvement (QI) metrics, specificaly door to computed tomography time (DTCT), door to neurology time (DTN), and door to tPA administration time (DTT). Methods: Our institutional stroke algorithm underwent extensive revision, with a focus on removing variability, streamlining care, and improving time delays. The updated stroke algorithm was implemented in May 2012. Three primary stroke QI metrics were evaluated over four separate 3-month time points, one pre- and three post-algorithm periods. Results: The following data points improved after algorithm implementation: average DTCT decreased from 39.9 to 12.8 min ( P < 0.001); average DTN decreased from 34.1 to 8.2 min ( P ≤ 0.001), and average DTT decreased from 62.5 to 43.5 min ( P = 0.17). Conclusion: A new stroke protocol that prioritized neurointervention at our institution resulted in significant lowering in the DTCT and DTN, with a nonsignificant improvement in DTT. Competing Interests: The study was approved by Institutional Review Board (#140895).
Databáze:	MEDLINE
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