Efforts to reduce the door-to-needle time of thrombolysis in acute ischemic stroke: Video-assisted therapeutic risk communication

Hsieh, Cheng Yang; Chen, Wei Fen; Chen, Chih‐Hung; Wang, Chih‐Yuan; Chen, Chien Jung; Lai, Edward Chia Cheng; Chen, Tsang Shan

doi:10.1016/j.jfma.2013.11.012

Cited by 12 publications

(5 citation statements)

References 17 publications

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“…In recent years, there were several studies evaluating the effects of similar implemented programs on the performance of thrombolysis. Those studies with a clear-cut comparison of the thrombolytic rate or functional outcome before and after the intervention, alone with the present study, were summarized in Table S2 (for the methods and results of the literature review, please referred to the Supporting Information S2 ) [15] , [18] – [22] , [25] – [27] . A meta-analysis of these studies demonstrated a two-fold increase in chance of thrombolysis rate after the intervention ( Figure 2 ).…”

Section: Discussionmentioning

confidence: 99%

“…Acute stroke care implemented with “Stroke Code” (SC) or similar strategies is reported in several studies to enhance IV-tPA administration and reduce door-to-needle (DTN) time [13] – [27] . Current guidelines of the American Heart Association/American Stroke Association (AHA/ASA) recommend a door-to-computed tomography (CT) completed within 25 min and a DTN time within 60 min [28] , [29] .…”

Section: Introductionmentioning

confidence: 99%

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Stroke Code Improves Intravenous Thrombolysis Administration in Acute Ischemic Stroke

et al. 2014

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Background and PurposeTimely intravenous (IV) thrombolysis for acute ischemic stroke is associated with better clinical outcomes. Acute stroke care implemented with “Stroke Code” (SC) may increase IV tissue plasminogen activator (tPA) administration. The present study aimed to investigate the impact of SC on thrombolysis.MethodsThe study period was divided into the “pre-SC era” (January 2006 to July 2010) and “SC era” (August 2010 to July 2013). Demographics, critical times (stroke symptom onset, presentation to the emergency department, neuroimaging, thrombolysis), stroke severity, and clinical outcomes were recorded and compared between the two eras.ResultsDuring the study period, 5957 patients with acute ischemic stroke were admitted; of these, 1301 (21.8%) arrived at the emergency department within 3 h of stroke onset and 307 (5.2%) received IV-tPA. The number and frequency of IV-tPA treatments for patients with an onset-to-door time of <3 h increased from the pre-SC era (n = 91, 13.9%) to the SC era (n = 216, 33.3%) (P<0.001). SC also improved the efficiency of IV-tPA administration; the median door-to-needle time decreased (88 to 51 min, P<0.001) and the percentage of door-to-needle times ≤60 min increased (14.3% to 71.3%, P<0.001). The SC era group tended to have more patients with good outcome (modified Rankin Scale ≤2) at discharge (49.5 vs. 39.6%, P = 0.11), with no difference in symptomatic hemorrhage events or in-hospital mortality.ConclusionThe SC protocol increases the percentage of acute ischemic stroke patients receiving IV-tPA and decreases door-to-needle time.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Stroke Code Improves Intravenous Thrombolysis Administration in Acute Ischemic Stroke

et al. 2014

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“…The procedure could then be explained while the patient is waiting for the transfer. In the previous thrombolysis research in south Taiwan, obtaining informed consent was identified as one of the most important factors causing delay (37). In addition, failure to obtain informed consent was the reason why 21.1% of the eligible patients did not receive tissue plasminogen thrombolysis (38).…”

Section: Discussionmentioning

confidence: 99%

Use of a Smartphone Application to Speed Up Interhospital Transfer of Acute Ischemic Stroke Patients for Thrombectomy

et al. 2021

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Background: In most countries, large cerebral artery occlusion is identified as the leading cause of disability. In 2015, five large-scale clinical trials confirmed the benefit of intra-arterial thrombectomy. However, thrombectomy is a highly technical and facility-dependent procedure. Primary stroke centers need to transfer patients to comprehensive stroke centers to perform thrombectomy. The time-lapse during interhospital transfer would decrease the chance of the patient's proper recovery. Communication barriers also contribute to this delay.Aims: We used a smartphone application to overcome communication barriers between hospitals. We aimed to shorten the door-to-puncture time of interhospital transfer patients.Methods: We began using a smartphone application, “LINE,” to facilitate interhospital communication on May 01, 2018. We carried out retrospective data analyses for all the transfer patients (n = 351), with the primary outcome being the door-to-puncture time in our comprehensive stroke center (China Medical University Hospital). We compared the three periods: May 01 to Dec 31, 2017 (before the use of the smartphone application); May 01 to Dec 31, 2018 (the 1st year of using the smartphone application); and May 01 to Dec 31, 2019 (the 2nd year of using the smartphone application). We also compared the transfer data with non-transfer thrombectomies in the same period.Results: We compared 2017, 2018, and 2019 data. The total number of transfer patients increased over the years: 63, 113, 175, respectively. The mean door-to-puncture time decreased significantly, going from 109, through 102, to 92 min. Meanwhile, the mean door-to-puncture time in non-transfer patients were 140.3, 122.1, and 129.3 min. The main reason of time saving was the change of the way of communication, from point-to-point interhospital communication to hub-to-spoke interhospital communication.Conclusions: We used this smartphone application to enhance interhospital communication, changed from the point-to-point to hub-to-spoke method. It made us overcome the communication barrier and build up interhospital connection, thus shortening the door-to-puncture time. Our experience demonstrated the importance of close communication and teamwork in hyperacute stroke care, especially in interhospital transfer for thrombectomy.

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“…A previous study in Taiwan also indicated that the time interval between symptom onset and the decision to call for medical care was far from optimal and was the underlying cause of prolonged prehospital delay [19]. Another study demonstrated that a new designed program with video-assisted therapeutic risk communication significantly decreased the door-to-needle time and increased the percentage of rtPA thrombolytic therapy in patients with AIS [20]. However, the study did not include the data of onset to ER arrival and door to needle time intervals.…”

Section: Discussionmentioning

confidence: 99%

Nationwide “Hospital Emergent Capability Accreditation by Level-Stroke” Improves Stroke Treatment in Taiwan

et al. 2017

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Background and Purpose Recombinant tissue plasminogen activator (rtPA) is one of the proven therapies that improve the outcome of patients with acute ischemic stroke (AIS). In 2009, the Ministry of Health and Welfare, Executive Yuan, Republic of China, launched the project “Hospital Emergent Capability Accreditation by Level-Stroke (HECAL-Stroke)” to improve AIS treatment in Taiwan. The current study was performed to determine whether the project launched by the government was effective in promoting rtPA therapy among AIS patients. Methods All participating hospitals were verified and designated as “heavy duty (HD),” “moderate duty (MoD),” or “medium duty (MeD)” according to the stroke center criteria. Four annual indices (rates of treatment, protocol adherence, in-time treatment, and complications) were recorded from 2009 to 2014 as outcome measures. The data were analyzed using the χ2 test for significance. Results The number of certified hospitals progressively increased from 74 to 112 during the 6-year period and finally consisted of 33 HD, 9 MoD and 70 MeD hospitals in 2014. The annual intravenous rtPA treatment rate increased significantly from 3.0% in 2009 to 4.5% in 2014. The protocol adherence rates were 95.7% in the HD group, 92.4% in the MoD group and 72.8% in the MeD group. The annual in-time treatment rate significantly improved from 26.0% in 2009 to 60.1% in 2014. The overall symptomatic intracranial hemorrhagic rate after rtPA treatment was 8.6%. Conclusions Initiation of the HECAL-Stroke project by the government significantly improved rtPA treatment in Taiwan.

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Efforts to reduce the door-to-needle time of thrombolysis in acute ischemic stroke: Video-assisted therapeutic risk communication

Abstract: A thrombolysis program with video-assisted therapeutic risk communication decreased DTN time and increased the treatment rate of patients with AIS.

Cited by 12 publications

References 17 publications

Stroke Code Improves Intravenous Thrombolysis Administration in Acute Ischemic Stroke

Stroke Code Improves Intravenous Thrombolysis Administration in Acute Ischemic Stroke

Use of a Smartphone Application to Speed Up Interhospital Transfer of Acute Ischemic Stroke Patients for Thrombectomy

Nationwide “Hospital Emergent Capability Accreditation by Level-Stroke” Improves Stroke Treatment in Taiwan

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