Prehospital and Emergency Department-Focused Mission Protocol Improves Thrombolysis Metrics for Suspected Acute Stroke Patients

Autor: Christine Martin, Debbie Y Madhok, Kevin J Keenan, Sara Cole, J. Claude Hemphill rd
Rok vydání: 2019
Předmět:
Male
Emergency Medical Services
medicine.medical_specialty
Time Factors
medicine.medical_treatment
education
Brain Ischemia
Time-to-Treatment
Diagnosis
Differential
03 medical and health sciences
0302 clinical medicine
Clinical Protocols
Fibrinolytic Agents
Predictive Value of Tests
medicine
Humans
Thrombolytic Therapy
Suspected stroke
General hospital
Stroke
Aged
Quality Indicators
Health Care
Retrospective Studies
Acute stroke
Aged
80 and over
Protocol (science)
business.industry
Stroke scale
Rehabilitation
Thrombolysis
Emergency department
Middle Aged
medicine.disease
Quality Improvement
Outcome and Process Assessment
Health Care
Treatment Outcome
Emergency medicine
Female
Surgery
Neurology (clinical)
Emergency Service
Hospital
Tomography
X-Ray Computed
Cardiology and Cardiovascular Medicine
business
030217 neurology & neurosurgery
Zdroj: Journal of Stroke and Cerebrovascular Diseases. 28:104423
ISSN: 1052-3057
DOI: 10.1016/j.jstrokecerebrovasdis.2019.104423
Popis: The Mission Protocol was implemented in 2017 to expedite stroke evaluation and reduce door-to-needle (DTN) times at Zuckerberg San Francisco General Hospital. The key system changes were team-based evaluation of suspected stroke patients at ambulance entrance by an Emergency Department (ED) physician, ED nurse, and neurologist and immediate emergency medical service (EMS) provider transport of patients to CT.Patients were eligible for a Mission Protocol prehospital stroke activation if an EMS provider found a positive Cincinnati Prehospital Stroke Scale and a last known normal time within 6 hours. We retrospectively compared treatment metrics between the first year of Mission Protocol patients and patients from the year prior also brought in via ambulance with suspected stroke and a last known normal time within 6 hours. Median Door to CT and DTN times were compared using 2 sample Wilcoxon rank-sum (Mann-Whitney) tests.There were 236 patients in the Mission Protocol group and 112 in the comparison group. The Mission Protocol was associated with a 10 minutes faster median door to CT time (P.00001), a 6 minutes faster median DTN time (P = .0046), a 22% increase in the proportion of patients treated within 45 minutes of arrival (84% versus 62%), and a 12% increase in the proportion of patients treated within 60 minutes (92% versus 80%). There were 8 stroke mimics treated in the Mission Protocol cohort compared to 2 in the comparison cohort. Symptomatic intracranial hemorrhage occurred in one Mission Protocol patient with an ischemic stroke.The EMS direct to CT based Mission Protocol was associated with faster median door to CT and DTN times. There was a 22% increase in the proportion of thrombolysis patients treated within 45 minutes or less. More stroke mimic patients received thrombolysis but symptomatic intracranial hemorrhage only occurred in 1 ischemic stroke patient.
Databáze: OpenAIRE
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