Is Door-to-Needle Time Reduced for Emergency Medical Services Transported Stroke Patients Routed Directly to the Computed Tomography Scanner on Emergency Department Arrival?

Sloane, Bryan; Bosson, Nichole; Sanossian, Nerses; Saver, Jeffrey L.; Perez, Lorrie; Gausche‐Hill, Marianne

doi:10.1016/j.jstrokecerebrovasdis.2019.104477

Cited by 7 publications

(7 citation statements)

References 25 publications

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“…We found 49 studies containing information on intra-hospitalar organizational factors associated with delays or access to ART ( Appendix A - Table A3 ). Training emergency room professionals [ 61 , 62 , 63 , 64 , 65 , 66 ], promotion of specific stroke code protocols [ 30 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 ], direct transfer from ambulance to the imaging room [ 86 , 87 , 88 , 89 , 90 , 91 , 92 ], strategic location of the imaging room (IR) [ 93 ], and routine administration of thrombolysis in the IR, were considered effective strategies to reduce thrombolysis delay [ 68 , 69 , 85 , 86 , 87 , 88 , 89 , 94 , 95 ]. In places where the physician, usually a neurologist, responsible for thrombolysis, is on-call, pre-notification of possible stroke before imaging also reduced delays [ 37 , 68 , …”

Section: Resultsmentioning

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: Resultsmentioning

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%

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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“…Several studies have proposed and evaluated various methods to reduce the DTC times [ 7 , 8 , 9 , 10 ]. The proposed methods were used to create quality improvement teams, review and change current protocols and routines, develop mobile apps, and organize off-site quality meetings.…”

Section: Introductionmentioning

confidence: 99%

Low-Cost Feedback Program for Reducing the Door-to-Computed Tomography Time

Mitsuhashi

Tokugawa

Mitsuhashi

2022

Cerebrovasc Dis Extra

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Introduction: Early restoration of blood flow in stroke patients can be achieved by reducing the door-to-computed tomography (DTC) time. Previous research has proposed several methods to reduce the DTC time, but the implementation costs limit its transferability. This study aimed to propose a novel, simple, and low-cost method for reducing the DTC time by providing feedback on each patient’s DTC time to a small group of medical workers and physicians. Methods: A field experiment was conducted for 233 days, and the DTC time of 249 patients with stroke symptoms who were transported via ambulance to a medium-sized university hospital in Japan within 24 h after stroke onset was obtained. The first and second feedback reports on the 59th day and 154th day, respectively, were provided at the beginning of the field experiment. Using the data collected during the first 58 days as baseline data, the baseline data were compared with the post-intervention data. As part of the intervention, feedback on the DTC time for each patient was provided to six medical workers and physicians during regular meetings. The primary outcome was a continuous measure of DTC time (in min). The feedback effect hypothesis was formulated prior to data collection. Results: In a sample of 68 patients at baseline, the mean DTC time was 18.16 min with a standard deviation of 7.38 min. As a result of the two feedback reports, in the sample with outliers, the mean and standard deviation decreased to 15.64 min and 5.97 min, respectively. The difference in means was 2.51 min (p = 0.021 in t tests). Results of the test of the equality of the standard deviations suggested that the two standard deviations were not equal (p = 0.065). Conclusions: The low-cost interventions successfully reduced both the mean DTC time and variation, suggesting an improvement in the quality and consistency of medical services. The result of our fine-grained analysis with a field-experiment design supports the role of feedback in achieving early treatment as suggested in the Target: Stroke initiative.

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Is Door-to-Needle Time Reduced for Emergency Medical Services Transported Stroke Patients Routed Directly to the Computed Tomography Scanner on Emergency Department Arrival?

Cited by 7 publications

References 25 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

Low-Cost Feedback Program for Reducing the Door-to-Computed Tomography Time

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