Rapid response teams (RRT) improve speed and quality of urgent inpatient care. Nonetheless, its effectiveness depends on adequate problem identification and fast triggering of institutional procedures. Differences in patient profiles and team experience between medical (Me) or surgical (Su) wards may influence the response times to suspected intrahospital strokes. From January/2016 through April/2019, we retrospectively analyzed data in a large tertiary hospital in Brazil. There were proportionally more callings for suspected strokes in medical wards (36/281 [13%] Me vs. 16/619 [2%] Su, p<0.001) in relation to the total of calls for any reason, while the ratio of diagnostic confirmation was similar (19/36 [52%] Me vs. 10/16 [62%] Su, p=0.495). Ischemic strokes were more prevalent in both infirmaries (17/19 [89%] Me vs. 8/10 [80%] Su, p=0.43). While not statistically significant, there were numerical differences between time to symptom recognition and the interval between recognition and triggering of the RRT. Medical ward teams recognized symptoms on average 108 minutes after the presumed onset versus 164 minutes in surgical wards. Paradoxically, surgical teams more promptly called RRT after recognition, on average 93 versus 172 minutes. There were no statistical differences in the ratio of ischemic strokes submitted to intravenous thrombolysis (11/17 [35,3%] Me vs. 1/8 [12,5%] Su, p=0.25) or mechanical thrombectomy (2/17 [11,8%] Me vs. 0/8 Su, p=0.45), however it is possible that the small number of events (52 calls in 40 months) led to low statistical power. This study suggests there may be differences in initial responses to suspected intrahospital strokes between different ward profiles. These might be secondary to variations in patient characteristics and team education, but also be caused by a Dunning-Kruger phenomenon (i.e. a higher perception of knowledge on stroke care leading to delays in triggering institutional workflows). Identifying these divergences in further larger, prospective trials can help develop individualized interventions to improve the quality of care in these medical emergencies.
Background: Stroke is the second leading cause of death in Brazil. All stroke patients should receive care at a SU in accordance with the guidelines of the American Heart Association (AHA)/American Stroke Association (ASA) - Class of recommendation I. Our institution is provided with a SU since 2019. Objective: To describe the rate of medical complications at our SU. Design and setting: This is a longitudinal descriptive study settled at the ICHCFMUSP. Methods: The incidence of complications during hospitalization at the UAVC was prospectively recorded. The rates of pneumonia, pressure ulcer, urinary tract infection (UTI), and venous thromboembolism (VTE) were analyzed. The period analyzed was from january/2019 to december/2020. Results: 379 patients were admitted at our SU. 50 patients (13.1%) presented at least one complication. 35 patients had only 1 complication, 13 patients had 2 complications, 1 patient had 3 complications and 1 patient had 4 complications. The most frequent complication was UTIs (7.9%), followed by pneumonia (5%), pressure ulcer (2.3%) and VTE (2.3%). 4 patients died during hospitalization at the SU. Conclusion: The rate of complications in our SU is low according to the literature.
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