Collaborative Interventions Reduce Time-to-Thrombolysis for Acute Ischemic Stroke in a Public Safety Net Hospital
| Autor: | Threlkeld, Zachary D, Kozak, Benjamin, McCoy, David, Cole, Sara, Martin, Christine, Singh, Vineeta |
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| Rok vydání: | 2017 |
| Předmět: |
Male
Time Factors Computed Tomography Angiography Clinical Sciences and over Brain Ischemia Workflow Time-to-Treatment Fibrinolytic Agents Integrated 80 and over Humans Thrombolytic Therapy safety net hospital Cooperative Behavior Retrospective Studies Aged Patient Care Team Neurology & Neurosurgery Neurosciences cerebrovascular disorders Middle Aged Public Hospitals Cerebral Angiography Brain Disorders Stroke Treatment Outcome Tissue Plasminogen Activator Critical Pathways Interdisciplinary Communication Female Delivery of Health Care Safety-net Providers |
| Zdroj: | Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, vol 26, iss 7 Threlkeld, ZD; Kozak, B; McCoy, D; Cole, S; Martin, C; & Singh, V. (2017). Collaborative Interventions Reduce Time-to-Thrombolysis for Acute Ischemic Stroke in a Public Safety Net Hospital. JOURNAL OF STROKE & CEREBROVASCULAR DISEASES, 26(7), 1500-1505. doi: 10.1016/j.jstrokecerebrovasdis.2017.03.004. UC San Francisco: Retrieved from: http://www.escholarship.org/uc/item/79d9c380 |
| Popis: | Background and purposeShorter time-to-thrombolysis in acute ischemic stroke (AIS) is associated with improved functional outcome and reduced morbidity. We evaluate the effect of several interventions to reduce time-to-thrombolysis at an urban, public safety net hospital.MethodsAll patients treated with tissue plasminogen activator for AIS at our institution between 2008 and 2015 were included in a retrospective analysis of door-to-needle (DTN) time and associated factors. Between 2011 and 2014, we implemented 11 distinct interventions to reduce DTN time. Here, we assess the relative impact of each intervention on DTN time.ResultsThe median DTN time pre- and postintervention decreased from 87 (interquartile range: 68-109) minutes to 49 (interquartile range: 39-63) minutes. The reduction was comprised primarily of a decrease in median time from computed tomography scan order to interpretation. The goal DTN time of 60 minutes or less was achieved in 9% (95% confidence interval: 5%-22%) of cases preintervention, compared with 70% (58%-81%) postintervention. Interventions with the greatest impact on DTN time included the implementation of a stroke group paging system, dedicated emergency department stroke pharmacists, and the development of a stroke code supply box.ConclusionsMultidisciplinary, collaborative interventions are associated with a significant and substantial reduction in time-to-thrombolysis. Such targeted interventions are efficient and achievable in resource-limited settings, where they are most needed. |
| Databáze: | OpenAIRE |
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