Improvement in Door-to-Needle Time in Patients with Acute Ischemic Stroke via a Simple Stroke Activation Protocol

Tan, Benjamin Yong-Qiang; Ngiam, Jinghao Nicholas; Sunny, Sumsum; Kong, Wan Yee; Tam, Howen; Sim, Terence; Leong, Benjamin Sieu Hon; Chandra, Bharatendu; Paliwal, Prakash; Seet, Raymond C.S.; Chan, Bernard P.L.; Teoh, Hock Luen; Sharma, Vijay K.; Yeo, Leonard L.L.

doi:10.1016/j.jstrokecerebrovasdis.2018.01.005

Cited by 25 publications

(21 citation statements)

References 20 publications

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“…The initial treatment of acute ischaemic stroke (AIS) is both time-sensitive and has a large impact on functional outcomes [6]. It is crucial to continue delivering this service to patients who need it [7]. However, given the current pandemic, it will be a dilemma to balance appropriate delivery of care with reducing unnecessary exposure of healthcare staff to SARS-CoV-2.…”

Section: Introductionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on hyperacute stroke treatment: experience from a comprehensive stroke centre in Singapore

Paliwal

Tan

Leow

et al. 2020

J Thromb Thrombolysis

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The Coronavirus disease 2019 (COVID-19) pandemic is rapidly evolving and affecting healthcare systems across the world. Singapore has escalated its alert level to Disease Outbreak Response System Condition (DORSCON) Orange, signifying severe disease with community spread. We aimed to study the overall volume of AIS cases and the delivery of hyperacute stroke services during DORSCON Orange. This was a single-centre, observational cohort study performed at a comprehensive stroke centre responsible for AIS cases in the western region of Singapore, as well as providing care for COVID-19 patients. All AIS patients reviewed as an acute stroke activation in the Emergency Department (ED) from November 2019 to April 2020 were included. System processes timings, treatment and clinical outcome variables were collected. We studied 350 AIS activation patients admitted through the ED, 206 (58.9%) pre-and 144 during DORSCON Orange. Across the study period, number of stroke activations showed significant decline (p = 0.004, 95% CI 6.513 to − 2.287), as the number of COVID-19 cases increased exponentially, whilst proportion of activations receiving acute recanalization therapy remained stable (p = 0.519, 95% CI − 1.605 to 2.702). Amongst AIS patients that received acute recanalization therapy, early neurological outcomes in terms of change in median NIHSS at 24 h (-4 versus-4, p = 0.685) were largely similar between the pre-and during DORSCON orange periods. The number of stroke activations decreased while the proportion receiving acute recanalization therapy remained stable in the current COVID-19 pandemic in Singapore.

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Section: Introductionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on hyperacute stroke treatment: experience from a comprehensive stroke centre in Singapore

Paliwal

Tan

Leow

et al. 2020

J Thromb Thrombolysis

Self Cite

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“…Our experience is consistent with the reports from other medical systems that have implemented stroke alert systems to reduce door-to-needle time. [10][11][12] Notably, the present study demonstrated that the door-to-groin puncture time for thrombectomy candidates was also markedly reduced by pre-arrival notification, enabling the majority of patients to undergo groin puncture within 120 minutes. This is likely due to the longer time required to coordinate the neurointerventionist, interventional suite, and anaesthesiology care team; this process was initiated early with pre-arrival stroke notification.…”

Section: Discussionmentioning

confidence: 61%

Pre-hospital stroke screening and notification of patients with reperfusion-eligible acute ischaemic stroke using modified Face Arm Speech Time test

et al. 2020

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“…Some of their strategies include emphasizing an interdisciplinary approach, 30 adapting stroke alert algorithms for the inpatient setting, 23,25 and incorporating pharmacists and dedicated nurses to the inpatient stroke team. [31][32][33] This study adds evidence that a similar intervention could be implemented at other hospitals to improve AIS metrics.…”

Section: Limitationsmentioning

confidence: 77%

Identifying and Addressing Barriers to Systemic Thrombolysis for Acute Ischemic Stroke in the Inpatient Setting: A Quality Improvement Initiative

Pines

Das

Bhatt

et al. 2020

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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Objectives To identify barriers to inpatient alteplase administration and implement an interdisciplinary program to reduce time to systemic thrombolysis. Patients and Methods Compared with patients presenting to the emergency department with an acute ischemic stroke (AIS), inpatients are delayed in receiving alteplase for systemic thrombolysis. Institutional AIS metrics were extracted from the electronic medical records of patients presenting as an inpatient stroke alert. All patients who received alteplase for AIS were included in the analysis. A gap analysis was used to assess institutional deficiencies. An interdisciplinary intervention was initiated to address these deficiencies. Efficacy was measured with pre- and postintervention surveys and institutional AIS metric analysis. Statistical significance was determined using the Student t test. We identified 5 patients (mean age, 73 years; 100% (5/5) male; 80% (4/5) white) who met inclusion criteria for the preintervention period (January 1, 2017, to December 31, 2017) and 10 patients (mean age, 71 years; 50% male; 80% white) for the postintervention period (October 31, 2018, to July 1, 2020). Results We found barriers to rapid delivery of thrombolytic treatment to include alteplase availability and comfort with bedside reconstitution. Interdisciplinary intervention strategies consisted of stocking alteplase on additional floors as well as structured education and hands-on alteplase reconstitution simulations for resident physicians. The mean time from stroke alert to thrombolysis was shorter postintervention than preintervention (57.4 minutes vs 77.8 minutes; P =.03). Conclusion A coordinated interdisciplinary approach is effective in reducing time to systemic thrombolysis in patients experiencing AIS in the inpatient setting. A similar program could be implemented at other institutions to improve AIS treatment.

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Improvement in Door-to-Needle Time in Patients with Acute Ischemic Stroke via a Simple Stroke Activation Protocol

Cited by 25 publications

References 20 publications

Impact of the COVID-19 pandemic on hyperacute stroke treatment: experience from a comprehensive stroke centre in Singapore

Impact of the COVID-19 pandemic on hyperacute stroke treatment: experience from a comprehensive stroke centre in Singapore

Pre-hospital stroke screening and notification of patients with reperfusion-eligible acute ischaemic stroke using modified Face Arm Speech Time test

Identifying and Addressing Barriers to Systemic Thrombolysis for Acute Ischemic Stroke in the Inpatient Setting: A Quality Improvement Initiative

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