Identifying and Addressing Barriers to Systemic Thrombolysis for Acute Ischemic Stroke in the Inpatient Setting: A Quality Improvement Initiative
| Autor: | Devika M. Das, Vanesa K Vanderhye, Sara Dawit, Shubhang K. Bhatt, Andrew R. Pines, Harn J Shiue, Kara A Sands |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Quality management CT computerized tomography medicine.medical_treatment AMDC automated medication dispensing cabinet RN registered nurse STN stroke-alert-to-needle 030204 cardiovascular system & hematology PCCU progressive cardiac care unit 03 medical and health sciences 0302 clinical medicine Statistical significance medicine 030212 general & internal medicine Stroke Acute ischemic stroke RRN rapid response nurse AHA American Heart Association lcsh:R5-920 business.industry Medical record AIS acute ischemic stroke NIHSS National Institutes of Health Stroke Scale EMR electronic medical record Emergency department Thrombolysis Inpatient setting medicine.disease Emergency medicine Original Article ED emergency department business lcsh:Medicine (General) DTB decision-to-treat-to-bolus IV intravenous |
| Zdroj: | Mayo Clinic Proceedings: Innovations, Quality & Outcomes Mayo Clinic Proceedings: Innovations, Quality & Outcomes, Vol 4, Iss 6, Pp 657-666 (2020) |
| ISSN: | 2542-4548 |
| Popis: | Objectives To identify barriers to inpatient alteplase administration and implement an interdisciplinary program to reduce time to systemic thrombolysis. Patients and Methods Compared with patients presenting to the emergency department with an acute ischemic stroke (AIS), inpatients are delayed in receiving alteplase for systemic thrombolysis. Institutional AIS metrics were extracted from the electronic medical records of patients presenting as an inpatient stroke alert. All patients who received alteplase for AIS were included in the analysis. A gap analysis was used to assess institutional deficiencies. An interdisciplinary intervention was initiated to address these deficiencies. Efficacy was measured with pre- and postintervention surveys and institutional AIS metric analysis. Statistical significance was determined using the Student t test. We identified 5 patients (mean age, 73 years; 100% (5/5) male; 80% (4/5) white) who met inclusion criteria for the preintervention period (January 1, 2017, to December 31, 2017) and 10 patients (mean age, 71 years; 50% male; 80% white) for the postintervention period (October 31, 2018, to July 1, 2020). Results We found barriers to rapid delivery of thrombolytic treatment to include alteplase availability and comfort with bedside reconstitution. Interdisciplinary intervention strategies consisted of stocking alteplase on additional floors as well as structured education and hands-on alteplase reconstitution simulations for resident physicians. The mean time from stroke alert to thrombolysis was shorter postintervention than preintervention (57.4 minutes vs 77.8 minutes; P=.03). Conclusion A coordinated interdisciplinary approach is effective in reducing time to systemic thrombolysis in patients experiencing AIS in the inpatient setting. A similar program could be implemented at other institutions to improve AIS treatment. |
| Databáze: | OpenAIRE |
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