Total Quality Improvement Method for Reduction of Delays Between Emergency Department Admission and Treatment of Acute Ischemic Stroke

Abstract

Total quality improvement methods identified ED-specific sources of process variability and reduced time between ED admission and treatment. Therefore, these methods should be considered in developing and monitoring emergent stroke treatment protocols.

Treatment With Tissue Plasminogen Activator and Inpatient Mortality Rates for Patients With Ischemic Stroke Treated in Community Hospitals

“…5,8 Our results also confirm observations that there is a large degree of variation in the proportion of patients who receive intravenous thrombolysis at individual hospitals. 5,8,9,15,16 Our estimate of inpatient death for patients treated with IV tPA is consistent with estimates reported in the literature based on clinical trial data as well as on data collected during routine practice (Table 5). Our point estimate of an inpatient mortality rate of 9.9% among 362 patients treated with IV tPA is 37% lower than that reported by Katzan et al, 5 which was based 70 patients treated with IV tPA in hospitals located in the Cleveland area.…”

Treatment With Tissue Plasminogen Activator and Inpatient Mortality Rates for Patients With Ischemic Stroke Treated in Community Hospitals

“…5,8 Our results also confirm observations that there is a large degree of variation in the proportion of patients who receive intravenous thrombolysis at individual hospitals. 5,8,9,15,16 Our estimate of inpatient death for patients treated with IV tPA is consistent with estimates reported in the literature based on clinical trial data as well as on data collected during routine practice (Table 5). Our point estimate of an inpatient mortality rate of 9.9% among 362 patients treated with IV tPA is 37% lower than that reported by Katzan et al, 5 which was based 70 patients treated with IV tPA in hospitals located in the Cleveland area.…”

Strategies Used by Hospitals to Improve Speed of Tissue-Type Plasminogen Activator Treatment in Acute Ischemic Stroke

“…All these best practice strategies have previously been reported to be effective in increasing the number of eligible patients treated or reported to reduce time to treatment in acute myocardial infarction and stroke. [15][16][17][18][19]23,36 A variety of factors may have attenuated relationships between individual strategies and DTN times in this study. For instance, we have previously reported that faster treatment is associated with advance hospital notification by EMS in a patient-level analysis.…”

The implementation of artificial intelligence significantly reduces door-in-door-out times in a primary care center prior to transfer

“…16 This same study showed that a symptom onset to reperfusion time of 150 min resulted in a 91% chance of functional independence, with this metric decreasing by 10% in the next hour and approximately 20% with each hour of delay that followed. 16 As represented in Figure 1, the diagnostic and transfer process was reduced after Viz LVO implementation by a number of steps that may have accounted for the significant improvement in the DIDO times within the PSC.…”

Treatment With Tissue Plasminogen Activator and Inpatient Mortality Rates for Patients With Ischemic Stroke Treated in Community Hospitals

“…5,8 Our results also confirm observations that there is a large degree of variation in the proportion of patients who receive intravenous thrombolysis at individual hospitals. 5,8,9,15,16 Our estimate of inpatient death for patients treated with IV tPA is consistent with estimates reported in the literature based on clinical trial data as well as on data collected during routine practice (Table 5). Our point estimate of an inpatient mortality rate of 9.9% among 362 patients treated with IV tPA is 37% lower than that reported by Katzan et al, 5 which was based 70 patients treated with IV tPA in hospitals located in the Cleveland area.…”

Strategies Used by Hospitals to Improve Speed of Tissue-Type Plasminogen Activator Treatment in Acute Ischemic Stroke

“…All these best practice strategies have previously been reported to be effective in increasing the number of eligible patients treated or reported to reduce time to treatment in acute myocardial infarction and stroke. [15][16][17][18][19]23,36 A variety of factors may have attenuated relationships between individual strategies and DTN times in this study. For instance, we have previously reported that faster treatment is associated with advance hospital notification by EMS in a patient-level analysis.…”

The implementation of artificial intelligence significantly reduces door-in-door-out times in a primary care center prior to transfer

“…16 This same study showed that a symptom onset to reperfusion time of 150 min resulted in a 91% chance of functional independence, with this metric decreasing by 10% in the next hour and approximately 20% with each hour of delay that followed. 16 As represented in Figure 1, the diagnostic and transfer process was reduced after Viz LVO implementation by a number of steps that may have accounted for the significant improvement in the DIDO times within the PSC.…”

Treatment With Tissue Plasminogen Activator and Inpatient Mortality Rates for Patients With Ischemic Stroke Treated in Community Hospitals

“…5,8 Our results also confirm observations that there is a large degree of variation in the proportion of patients who receive intravenous thrombolysis at individual hospitals. 5,8,9,15,16 Our estimate of inpatient death for patients treated with IV tPA is consistent with estimates reported in the literature based on clinical trial data as well as on data collected during routine practice (Table 5). Our point estimate of an inpatient mortality rate of 9.9% among 362 patients treated with IV tPA is 37% lower than that reported by Katzan et al, 5 which was based 70 patients treated with IV tPA in hospitals located in the Cleveland area.…”

Strategies Used by Hospitals to Improve Speed of Tissue-Type Plasminogen Activator Treatment in Acute Ischemic Stroke

“…All these best practice strategies have previously been reported to be effective in increasing the number of eligible patients treated or reported to reduce time to treatment in acute myocardial infarction and stroke. [15][16][17][18][19]23,36 A variety of factors may have attenuated relationships between individual strategies and DTN times in this study. For instance, we have previously reported that faster treatment is associated with advance hospital notification by EMS in a patient-level analysis.…”

The implementation of artificial intelligence significantly reduces door-in-door-out times in a primary care center prior to transfer

“…16 This same study showed that a symptom onset to reperfusion time of 150 min resulted in a 91% chance of functional independence, with this metric decreasing by 10% in the next hour and approximately 20% with each hour of delay that followed. 16 As represented in Figure 1, the diagnostic and transfer process was reduced after Viz LVO implementation by a number of steps that may have accounted for the significant improvement in the DIDO times within the PSC.…”