Ischemic stroke: clinical pathway impact

Abstract

Purpose A clinical pathway for patients with acute ischemic stroke was implemented in 2014 by one Italian teaching hospital multidisciplinary team. The purpose of this paper is to determine whether this clinical pathway had a positive effect on patient management by comparing performance data. Design/methodology/approach Volume, process and outcome indicators were analyzed in a pre-post retrospective observational study. Patients’ (admitted in 2013 and 2015) medical records with International Classification of Diseases, ICD-9 code 433.x (precerebral artery occlusion and stenosis), 434.x (cerebral artery occlusion) and 435.x (transient cerebral ischemia) and registered correctly according to hospital guidelines were included. Findings An increase context-sensitive in-patient numbers with more severe cerebrovascular events and an increase in patient transfers from the Stroke to Neurology Unit within three days (70 percent, p=0.25) were noted. Clinical pathway implementation led to an increase in patient flow from the Emergency Department to dedicated specialized wards such as the Stroke and Neurology Unit (23.7 percent, p<0.001). Results revealed no statistically significant decrease in readmission rates within 30 days (5.7 percent, p=0.85) and no statistically significant differences in 30-day mortality. Research limitations/implications The pre-post retrospective observational study design was considered suitable to evaluate likely changes in patient flow after clinical pathway implementation, even though this design comes with limitations, describing only associations between exposure and outcome. Originality/value Clinical pathway implementation showed an overall positive effect on patient management and service efficiency owing to the standardized application in time-dependent protocols and multidisciplinary/integrated care implementation, which improved all phases in acute ischemic stroke care.

Construction of Clinical Pathway Information Management System under the Guidance of Evidence-Based Medicine

“…In addition, there is also the idea that clinical pathways are only a formalized management method and have no practical value. Moreover, some people hold that the clinical pathway is just a reengineered diagnosis and treatment standard and it is meaningless [ 14 ]. Under these real problems, it is necessary to digitalize the information of clinical pathway and establish an information management system.…”

Effect of lockdown on the management of ischemic stroke: an Italian experience from a COVID hospital

“…Acknowledgment STROKE TEAM Collaborators: Antonio Giulio De Belvis 3,4 ; Carmen Angioletti 4 , Irene Scala 2 , Jessica Marotta 2 , Simone Bellavia 2 , Giuseppe Reale 1 , Alberto Mariano Pennisi 2,5 , Francesco Franceschi 2,5 , Anselmo Caricato 2,5 , Alessandro Pedicelli 2,6 , Francesco D'Argento 6 , Iacopo Valente 6 , Emilio Lozupone 6 , Andrea Alexandre 6 1 Authors' contributions Giovanni Frisullo, Valerio Brunetti, Riccardo Di Iorio, and Giacomo Della Marca: design and conceptualized the study; acquired, analyzed, and interpreted the data; drafted and revised the manuscript for intellectual content.…”

“…Intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT) in ischemic stroke (IS) are extremely time-sensitive. The "hub-andspoke model" in the pre-hospital phase and the definition of ICPs with standardized processes within the in-hospital phase are essential to reduce delay and increase the number of treatable patients [2][3][4].…”

Perfil Epidemiológico Da Morbimortalidade Da Doença De Alzheimer Em Alagoas E No Nordeste Brasileiro

“…Referente aos distúrbios visuoespaciais, manifestações clínicas dos AVCs em lobo occipital como a agnosia visual são singulares no que se refere à distribuição dos fatores de risco, etiologia e prognósticos a longo prazo em relação aos infartos localizados em outras áreas do cérebro (BELVIS et al, 2019).…”