Efficacy of New Measures Saving Time in Acute Stroke Management: A Quantified Analysis

Mohedano, A.M. Iglesias; Pastor, A. García; Otero, Francisco Javier Sanjiao; Alén, P. Vázquez; Montero, Marta Vales; Buzo, E. Luque; Ráfales, Nuria Redondo; Cano, Beatriz Chavarria; Bullido, Y. Fernández; Osorio, José; Núñez, A. Gil

doi:10.1016/j.jstrokecerebrovasdis.2017.04.015

Cited by 6 publications

(4 citation statements)

References 19 publications

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“…Evaluation of stroke symptoms by emergency services is not linear and education of pre-hospital professionals also reduced pre-hospital delays [ 20 , 22 , 37 , 40 , 51 , 61 , 82 , 99 , 106 , 107 , 109 ]. Use of ambulance significantly reduced pre and intra-hospital delays, especially if pre-notification is made to the hospital allowing the hospital teams to check the patient’s previous clinical notes and the put everything involved in the chain of care in “preparedness mode” including the availability of the imaging room [ 12 , 15 , 16 , 17 , 20 , 22 , 23 , 37 , 39 , 40 , 44 , 48 , 51 , 61 , 92 , 96 , 97 , 98 , 110 , 111 , 112 , 113 ]. For time-dependent treatment, such as the ART, implementation of prehospital [ 51 , 61 , 75 , 98 , 107 ] and intrahospital [ 48 , 51 , 59 , 67 , 68 , 70 , 71 , 72 , 74 , 76 , 77 , 79 , 84...…”

Section: Discussionmentioning

confidence: 99%

Organizational Factors Determining Access to Reperfusion Therapies in Ischemic Stroke-Systematic Literature Review

Botelho

Rios

Fidalgo

et al. 2022

IJERPH

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Background: After onset of acute ischemic stroke (AIS), there is a limited time window for delivering acute reperfusion therapies (ART) aiming to restore normal brain circulation. Despite its unequivocal benefits, the proportion of AIS patients receiving both types of ART, thrombolysis and thrombectomy, remains very low. The organization of a stroke care pathway is one of the main factors that determine timely access to ART. The knowledge on organizational factors influencing access to ART is sparce. Hence, we sought to systematize the existing data on the type and frequency of pre-hospital and in-hospital organizational factors that determine timely access to ART in patients with AIS. Methodology: Literature review on the frequency and type of organizational factors that determine access to ART after AIS. Pubmed and Scopus databases were the primary source of data. OpenGrey and Google Scholar were used for searching grey literature. Study quality analysis was based on the Newcastle-Ottawa Scale. Results: A total of 128 studies were included. The main pre-hospital factors associated with delay or access to ART were medical emergency activation practices, pre-notification routines, ambulance use and existence of local/regional-specific strategies to mitigate the impact of geographic distance between patient locations and Stroke Unit (SU). The most common intra-hospital factors studied were specific location of SU and brain imaging room within the hospital, and the existence and promotion of specific stroke treatment protocols. Most frequent factors associated with increased access ART were periodic public education, promotion of hospital pre-notification and specific pre- and intra-hospital stroke pathways. In specific urban areas, mobile stroke units were found to be valid options to increase timely access to ART. Conclusions: Implementation of different organizational factors and strategies can reduce time delays and increase the number of AIS patients receiving ART, with most of them being replicable in any context, and some in only very specific contexts.

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Section: Discussionmentioning

confidence: 99%

Organizational Factors Determining Access to Reperfusion Therapies in Ischemic Stroke-Systematic Literature Review

Botelho

Rios

Fidalgo

et al. 2022

IJERPH

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“…The time between the patient’s hospital arrival until the imaging exam (CT or MRI), called door-to-image time, decreased with protocol implementation in all studies that assessed it. It seems that this time was lower in patients who arrived with suspected stroke 16 , 40 , 51 , 52 , 53 and in those who arrived at hospitals which had the guideline to immediately direct them to the examination instead of referring it to another department of the hospital, 32 , 54 or for another exam. 52 Thus, the local health system first needs to have a reference hospital for the care of stroke cases, which has to be warned in advance about the patient’s arrival and organize for the direct referral of cases to an imaging exam.…”

Section: Discussionmentioning

confidence: 99%

“…It seems that this time was lower in patients who arrived with suspected stroke 16 , 40 , 51 , 52 , 53 and in those who arrived at hospitals which had the guideline to immediately direct them to the examination instead of referring it to another department of the hospital, 32 , 54 or for another exam. 52 Thus, the local health system first needs to have a reference hospital for the care of stroke cases, which has to be warned in advance about the patient’s arrival and organize for the direct referral of cases to an imaging exam. To succeed, hospitals have to train the administrative team of hospitals to reduce the time in performing the bureaucracies involved in the admission process of patients.…”

Section: Discussionmentioning

confidence: 99%

Reducing care time after implementing protocols for acute ischemic stroke: a systematic review

et al. 2022

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Background The treatment of acute ischemic stroke with cerebral reperfusion therapy requires rapid care and recognition of symptoms. Objective To analyze the effectiveness of implementing protocols for acute ischemic stroke in reducing care time. Methods Systematic review, which was performed with primary studies in Portuguese, English, and Spanish published between 2011 and 2020. Inclusion criteria: study population should comprise people with acute ischemic stroke and studies should present results on the effectiveness of using urgent care protocols in reducing care time. The bibliographic search was conducted in June 2020 in the LILACS, MEDLINE, Embase, Scopus, CINAHL, Academic Search Premier, and SocINDEX databases. The articles were selected, and data were extracted by two independent reviewers; the synthesis of the results was performed narratively. The methodological quality of articles was evaluated through specific instruments proposed by the Joanna Briggs Institute. Results A total of 11,226 publications were found, of which 35 were included in the study. Only one study reported improvement in the symptoms-onset-to-door time after protocol implementation. The effectiveness of the therapeutic approach protocols for ischemic stroke was identified in improving door-to-image, image-to-needle, door-to-needle and symptoms-onset-to-needle times. The main limitation found in the articles concerned the lack of clarity in relation to the study population. Conclusions Several advances have been identified in in-hospital care with protocol implementation; however, it is necessary to improve the recognition time of stroke symptoms among those who have the first contact with the person affected by the stroke and among the professionals involved with the prehospital care.

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“…(2022) estimated the Onset-to-Needle Time (ONT) to be 240, 145, and 156 minutes on average. [ 12 13 14 ]Also, Ding et al . (2019) reported the mean delay in receiving Alteplase in people who went directly to the studied hospitals as 164.7 minutes.…”

Section: Introductionmentioning

confidence: 99%

Delays in receiving Alteplase and related factors in patients with stroke referred to Shahid Beheshti Hospital in Kashan-Iran in 2020-2021

Sirousinejad,

Dianati,

Kheiran

et al. 2024

Journal of Education and Health Promotion

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BACKGROUND: The benefits of using Alteplase are time-dependent. This study aimed to evaluate delays between the onset of symptoms and the administration of Alteplase and related factors in patients with acute ischemic stroke (AIS). MATERIALS AND METHODS: In this cross-sectional study, 60 AIS patients receiving Alteplase were selected by census sampling from July 2020 to July 2021 from the eligible patients referred to Shahid Beheshti Hospital in Kashan, Iran. The data collection tool was a researcher-made questionnaire containing demographic information, time periods from the onset of symptoms to the injection of Alteplase, and associated factors. The required information was collected from the patients, their relatives, their health records, and Kashan Emergency Medical Service (EMS) information system. Data were analyzed in SPSS-16. RESULTS: Eighty-five percent of the 60 patients participating in the study were transferred to the hospital by EMS ambulances. The mean time intervals between different phases were as follows: Onset-To-Door (OTD) time 81.35 ± 33.76 minutes; Door-To-CT (DTC) scan time 16.12 ± 17.46 minutes; Door-To-Needle (DNT) time 51.30 ± 26.14 minutes; and the overall Onset-To-Needle (ONT) time 133.75 ± 39.17 minutes. Also, the mean ONT in people transferred by EMS was about 129 minutes, and the longest prehospital delay in these patients was related to the time between the arrival of the EMS ambulance to the hospital. Marital status and geographical location where the stroke had occurred showed a significant relationship with prehospital delay and pre-hospital notification (PHN) by EMS But there was no relationship between underlying diseases or economic status and prehospital delays; also, the patient’s diastolic blood pressure at the time of receiving Alteplase showed a significant relationship with in-hospital delay. CONCLUSION: The findings of the study showed that the majority of people trust and use EMS ambulances to transfer to the hospital and the time spent in different stages, from the onset of symptoms to the injection of the thrombolytic drug, was in an acceptable range in the patients.

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Efficacy of New Measures Saving Time in Acute Stroke Management: A Quantified Analysis

Cited by 6 publications

References 19 publications

Organizational Factors Determining Access to Reperfusion Therapies in Ischemic Stroke-Systematic Literature Review

Organizational Factors Determining Access to Reperfusion Therapies in Ischemic Stroke-Systematic Literature Review

Reducing care time after implementing protocols for acute ischemic stroke: a systematic review

Delays in receiving Alteplase and related factors in patients with stroke referred to Shahid Beheshti Hospital in Kashan-Iran in 2020-2021

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