Multidisciplinary Approach to Decrease In-Hospital Delay for Stroke Thrombolysis / 대한뇌졸중학회지
Journal of Stroke
;
: 196-204, 2017.
Article
in English
| WPRIM
| ID: wpr-72818
ABSTRACT
BACKGROUND AND PURPOSE:
Decreasing the time delay for thrombolysis, including intravenous thrombolysis (IVT) with tissue plasminogen activator and intra-arterial thrombectomy (IAT), is critical for decreasing the morbidity and mortality of patients experiencing acute stroke. We aimed to decrease the in-hospital delay for both IVT and IAT through a multidisciplinary approach that is feasible 24 h/day.METHODS:
We implemented the Stroke Alert Team (SAT) on May 2, 2016, which introduced hospital-initiated ambulance prenotification and reorganized in-hospital processes. We compared the patient characteristics, time for each step of the evaluation and thrombolysis, thrombolysis rate, and post-thrombolysis intracranial hemorrhage from January 2014 to August 2016.RESULTS:
A total of 245 patients received thrombolysis (198 before SAT; 47 after SAT). The median door-to-CT, door-to-MRI, and door-to-laboratory times decreased to 13 min, 37.5 min, and 8 min, respectively, after SAT implementation (P<0.001). The median door-to-IVT time decreased from 46 min (interquartile range [IQR] 36–57 min) to 20.5 min (IQR 15.8–32.5 min; P<0.001). The median door-to-IAT time decreased from 156 min (IQR 124.5–212.5 min) to 86.5 min (IQR 67.5–102.3 min; P<0.001). The thrombolysis rate increased from 9.8% (198/2,012) to 15.8% (47/297; P=0.002), and the post-thrombolysis radiological intracranial hemorrhage rate decreased from 12.6% (25/198) to 2.1% (1/47; P=0.035).CONCLUSIONS:
SAT significantly decreased the in-hospital delay for thrombolysis, increased thrombolysis rate, and decreased post-thrombolysis intracranial hemorrhage. Time benefits of SAT were observed for both IVT and IAT and during office hours and after-hours.
Full text:
Available
Index:
WPRIM (Western Pacific)
Main subject:
Thrombolytic Therapy
/
Cerebral Infarction
/
Mortality
/
Ambulances
/
Tissue Plasminogen Activator
/
Thrombectomy
/
Stroke
/
Intracranial Hemorrhages
Type of study:
Prognostic study
Limits:
Humans
Language:
English
Journal:
Journal of Stroke
Year:
2017
Type:
Article
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