Effect of Workflow Improvements on Time to Treatment in Endovascular Stroke Therapy: A Systematic Review

Janssen, Paula M.

doi:10.26226/morressier.5ab8f565d462b8029238d729

Cited by 4 publications

(4 citation statements)

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“…Die Etablierung von standardisierten Behandlungskonzepten, wie beispielsweise neurologischen Schockraumkonzepten, hilft die Versorgungszeiten zu optimieren und wird auch im Rahmen von Stroke-Unit-Zertifizierungen gefordert [81,82]. Ein Merkmal dieser Konzepte sind multiprofessionelle, interdisziplinäre Behandlungsteams (Stroke Teams) mit klarer Aufgabenverteilung, um eine optimale Behandlung rund um die Uhr gewährleisten zu können.…”

Section: Prozessoptimierung Der Innerklinischen Schlaganfallakutversounclassified

Therapie des akuten ischämischen Schlaganfalls

Schlemm¹,

Kestner²,

Bohmann³

et al. 2020

Nervenheilkunde

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ZUSAMMENFASSUNGDie Behandlungsmöglichkeiten des akuten ischämischen Schlaganfalls haben sich durch Weiterentwicklung bewährter und Erprobung neuer Therapieansätze in den letzten Jahren verbessert. Durch den Einsatz der erweiterten Akutbildgebung mittels multimodaler Computer- oder Magnetresonanztomografie konnte der Zugang zu Thrombolyse und Thrombektomie auch für ausgewählte Patienten mit unbekanntem oder bis zu 9 bzw. 24 h zurückliegendem Beginn der akuten Schlaganfallsymptomatik ermöglicht werden. Ergänzend zu diesen rekanalisierenden Akuttherapien zeigen adjuvante neuroprotektive und immunmodulatorische Behandlungsansätze vielversprechende Ergebnisse. Schließlich gewinnen eine verbesserte Zusammenarbeit der an der Schlaganfallversorgung beteiligten Fachdisziplinen und die Optimierung logistischer Prozesse an Bedeutung, um den zeitabhängigen Nutzen der Akuttherapie individuell zu maximieren. Der vorliegende Artikel fasst wesentliche aktuelle Studienergebnisse zur Akuttherapie des ischämischen Schlaganfalls zusammen und gibt Empfehlungen für eine evidenzbasierte Bildgebung als Grundlage effektiver Reperfusionstherapien.

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Section: Prozessoptimierung Der Innerklinischen Schlaganfallakutversounclassified

Therapie des akuten ischämischen Schlaganfalls

Schlemm¹,

Kestner²,

Bohmann³

et al. 2020

Nervenheilkunde

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“…5 While the time from symptom onset to admission can only be influenced at a policy level, door-to-groin and door-to-reperfusion times are highly dependent on intra-hospital procedures and structures. 6 Standard procedure in most hospitals is to triage suspected stroke patients by multidetector computed tomography (MDCT) or magnetic resonance imaging (MRI). If a target occlusion for MT is identified, the patient is then transported to the angiography suite for emergent MT.…”

Section: Introductionmentioning

confidence: 99%

Direct to angiography suite approaches for the triage of suspected acute stroke patients: a systematic review and meta-analysis

Tsogkas

Ospel

Appenzeller-Herzog³

et al. 2022

Ther Adv Neurol Disord

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Background: Increasing evidence suggests improved time metrics leading to better clinical outcomes when stroke patients with suspected large vessel occlusion (LVO) are transferred directly to the angiography suite (DTAS) compared with cross-sectional imaging followed by transfer to the angiography suite. We performed a systematic review and meta-analysis on the efficacy and safety of DTAS approaches. Methods: We searched Embase, Medline, Scopus, and clinicaltrials.gov for studies comparing outcomes of DTAS and conventional triage. Eligible studies were assessed for risk of bias. We performed a random-effects meta-analysis on the differences of median door-to-groin and door-to-reperfusion times between intervention and control group. Secondary outcomes included good outcome at 90 days (modified Rankin Scale ⩽ 2) rate of symptomatic intracranial hemorrhage (sICH) and mortality within 90 days. Results: Eight studies (one randomized, one cluster-randomized trial and six observational studies) with 1938 patients were included. Door-to-groin and door-to-reperfusion times in the intervention group were on median 29.0 min [95% confidence interval (CI): 14.3–43.6; p < 0.001] and 32.1 min (95% CI: 15.1–49.1; p < 0.001) shorter compared with controls. Prespecified subgroup analyses for transfer ( n = 1753) and mothership patients ( n = 185) showed similar reductions of the door-to-groin and door-to-reperfusion times in response to the intervention. The odds of good outcome did not differ significantly between both groups but were numerically higher in the intervention group (odds ratio: 1.38, 95% CI: 0.97–1.95; p = 0.07). There was no significant difference for mortality and sICH between the groups. Conclusion: DTAS approaches for the triage of suspected LVO patients led to a significant reduction in door-to-groin and door-to-reperfusion times but an effect on functional outcome was not detected. The subgroup analysis showed similar results for transfer and mothership patients. Registration: This study was registered in PROSPERO (CRD42020213621).

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“…Although there is significant evidence demonstrating this benefit, rates for using early interventions in acute stroke care, such as administering antiplatelet and fibrinolytic therapy, prenotification process, and overall access to stroke care, are suboptimal 4,5. These protocols notify the stroke team as well as anesthesia and radiology departments to be on standby as the patient is evaluated to determine whether they are a thrombectomy candidate 6,7. Once deemed a candidate, rapid transition from one department to another decreases time to treatment to ensure the best outcome and reversal of symptoms of an acute ischemic stroke (AIS).…”

Section: Introductionmentioning

confidence: 99%

Implementation of an Evidence-Based Prenotification Process for Patients With Stroke to Improve Neurological Outcomes

Gross

Gusler

Londy

et al. 2022

Journal of Neuroscience Nursing

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BACKGROUND: Endovascular mechanical thrombectomy can improve clinical outcomes in eligible patients with acute ischemic stroke (AIS), but its efficacy is time dependent. This quality improvement project aimed to examine whether a revised evidence-based neurological deficit algorithm initiated in the emergency department could reduce door-to-groin puncture time to less than 90 minutes and improve neurological outcomes in AIS patients who received mechanical thrombectomy. METHODS: Retrospective chart reviews occurred between September 2020 and April 2021, which included 25 patients. Clinical and time data were collected from AIS patients who were 18 years and older, presented for care with AIS symptoms, and deemed candidates for thrombectomy for a period of 6 months. A revised neurological deficit algorithm was initiated, and education was presented to appropriate staff. Postintervention chart reviews occurred from August 2021 to January 2022, which included 25 patients. RESULTS: Door-to-groin puncture time did not improve to less than 90 minutes; however, there was a slight improvement in time from 106 minutes in the preintervention to 98 minutes in the postintervention (P = .534). Although the outcome measures were not clinically significant, there was a statistically significant decrease in response time to acute stroke call down (P < .01). Door-to-computed tomography also improved, which was 14.42 minutes for the preintervention group and 5.25 minutes for the postintervention group (P < .001). Finally, the mean National Institutes of Health Stroke Scale on discharge for the preintervention group was 11.92, and that of the postintervention group was 6.05 on discharge (P < .01). CONCLUSIONS: Implementation of the revised neurological deficit algorithm did not decrease the door-to-groin puncture time to less than 90 minutes. After implementation of the revised neurologic deficit algorithm, there were single variable improvements in several benchmarks, and this is a starting point for future quality improvement projects.

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Effect of Workflow Improvements on Time to Treatment in Endovascular Stroke Therapy: A Systematic Review

Cited by 4 publications

References 0 publications

Therapie des akuten ischämischen Schlaganfalls

Therapie des akuten ischämischen Schlaganfalls

Direct to angiography suite approaches for the triage of suspected acute stroke patients: a systematic review and meta-analysis

Implementation of an Evidence-Based Prenotification Process for Patients With Stroke to Improve Neurological Outcomes

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