Streamlined triage and transfer protocols improve door-to-puncture time for endovascular thrombectomy in acute ischemic stroke

Kansagra, Akash P.; Wallace, Adam N.; Curfman, David; McEachern, James; Moran, Christopher J.; Cross, DeWitte T.; J, Lee; Ford, Andria L.; Manu, S. Goyal; Panagos, Peter D.; Derdeyn, Colin P.

doi:10.1016/j.clineuro.2018.01.026

Cited by 27 publications

(32 citation statements)

References 32 publications

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“…Additional interventions to optimize patient transfer management (eg, holding the initial ambulance primary stroke center until the decision of EVT eligibility has been made, streamlining transfer protocols, improving cloud-based image sharing, and transporting transfer patients directly to the angiosuite) might be useful to further reduce transfer-related delay in the future. 17–20…”

Section: Discussionmentioning

confidence: 99%

Effect of Interhospital Transfer on Endovascular Treatment for Acute Ischemic Stroke

Venema

Groot

Lingsma

et al. 2019

Stroke

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Section: Discussionmentioning

confidence: 99%

Effect of Interhospital Transfer on Endovascular Treatment for Acute Ischemic Stroke

Venema

Groot

Lingsma

et al. 2019

Stroke

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“…Many initiatives have focused on the reduction in door-to-treatment times (both with intravenous thrombolysis and endovascular therapy) and have achieved positive results in reducing times and improving patient outcomes. [50][51][52] Other time-sensitive emergencies, notably myocardial infarction, have focused on reducing door-to-treatment times with success in reducing times. 53 In understanding the primary importance of symptom onset to treatment in overall outcomes, efforts have logically evolved to extend beyond hospital treatment times, focusing on systems of care that include the public, partnership with EMS and referral hospitals to reduce prehospital times and improve the efficiency of the entire system.…”

Section: (10) Create a Culture Of Excellencementioning

confidence: 99%

Utstein recommendation for emergency stroke care

Rudd

Bladin

Carli³

et al. 2020

International Journal of Stroke

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Background Recent advances in treatment for stroke give new possibilities for optimizing outcomes. To deliver these prehospital care needs to become more efficient. Aim To develop a framework to support improved delivery of prehospital care. The recommendations are aimed at clinicians involved in prehospital and emergency health systems who will often not be stroke specialists but need clear guidance as to how to develop and deliver safe and effective care for acute stroke patients. Methods Building on the successful implementation program from the Global Resuscitation Alliance and the Resuscitation Academy, the Utstein methodology was used to define a generic chain of survival for Emergency Stroke Care by assembling international expertise in Stroke and Emergency Medical Services (EMS). Ten programs were identified for Acute Stroke Care to improve survival and outcomes, with recommendations for implementation of best practice. Conclusions Efficient prehospital systems for acute stroke will be improved through public awareness, optimized prehospital triage and timely diagnostics, and quick and equitable access to acute treatments. Documentation, use of metrics and transparency will help to build a culture of excellence and accountability.

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“…Stroke treatment has been revolutionized by the advent of endovascular thrombectomy (EVT) as the standard of care for acute ischemic stroke due to large vessel occlusion 1–3. As EVT case volumes at qualified centers increase due to expanding treatment indications and improved systems of care, the probability of multiple patients with large vessel occlusion presenting concurrently for time sensitive treatment is also expected to rise 2 4–11. New strategies are needed to ensure optimal care for these patients while maintaining sensitivity to the ever increasing demand on neurointerventionalists 12 13…”

Section: Introductionmentioning

confidence: 99%

“…Several authors have proposed strategies that may reduce the incidence of demand in excess of capacity (DEC). These strategies include a backup neurointerventional team, reduced procedure duration through equipment standardization, a distinct team to manage pre-intervention evaluation, optimized triage protocols, and diversion of patients to other hospitals 8 13–20. To date, however, there has been no quantitative assessment of the actual effectiveness of these strategies to reduce DEC.…”

Section: Introductionmentioning

confidence: 99%

Strategies to reduce the impact of demand for concurrent endovascular thrombectomy

Dalsania

Kansagra

2020

J NeuroIntervent Surg

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BackgroundThe rise in demand for endovascular thrombectomy (EVT) has increased the possibility that multiple patients with acute ischemic stroke may present concurrently and exceed local capacity to provide timely treatment. In this work, we quantitatively compared the efficacy of various strategies to mitigate demand in excess of capacity (DEC).MethodsStrategies evaluated included a backup neurointerventional team for 3 hours, 8 hours, or 24 hours per day; a separate pre-intervention imaging team; and a 30% decrease in procedure duration. For each strategy, empirical distributions were used to probabilistically generate arrival time and case duration for 16 000 independent trials repeated across a range of annual case volumes. DEC was calculated from time series representing the number of concurrent cases at each minute of the year for each trial at each case volume.ResultsAll strategies decreased DEC compared with baseline. At a representative volume of 250 cases per year, availability of a backup team for 3 hours, 8 hours, and 24 hours per day reduced DEC by 27.0%, 60.3%, and 97.2%, respectively, compared with baseline. Similarly, availability of a pre-intervention imaging team and a 30% decrease in procedure duration reduced DEC by 26.6% and 17.7%, respectively, compared with baseline.ConclusionsA backup neurointerventional team, even if available only part time, was an effective strategy for decreasing DEC for EVT. Understanding the actual quantitative benefit of each strategy can facilitate rational cost–benefit analyses underlying the development of efficient and sustainable models of care.

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Streamlined triage and transfer protocols improve door-to-puncture time for endovascular thrombectomy in acute ischemic stroke

Cited by 27 publications

References 32 publications

Effect of Interhospital Transfer on Endovascular Treatment for Acute Ischemic Stroke

Effect of Interhospital Transfer on Endovascular Treatment for Acute Ischemic Stroke

Utstein recommendation for emergency stroke care

Strategies to reduce the impact of demand for concurrent endovascular thrombectomy

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