Interventional study of endovascular treatment of in-hospital delay in patients with acute ischemic stroke in a tertiary hospital in Beijing / 中国脑血管病杂志

ABSTRACT

Objectives To analyze the links of the in-hospital delay by investigating the status of in-hospital delay in patients with acute ischemic stroke in a tertiary hospital in Beijing and to shorten the in-hospital delay by intervention. Methods From August 2016 to July 2017,98 patients with ischemic stroke treated by endovascular therapy and met the inclusion criteria in the Xuanwu Hospital, Capital Medical University were collected prospectively. According to before and after intervention,the patients were divided into before intervention (from August 2016 to January 2017,n=44) and after intervention (from February to July 2017,n=54). The questionnaire was designed by the authors. The survey included the basic information of patients,clinical features,and key time point of hospital treatment process. The delay links were analyzed through the value flow diagram,and the targeted interventions were given to shorten the time of in-hospital delay. Results (1) The main links of the presence of in-hospital delay are physician evaluation,disease notification, signing of the informed consent, and preoperative preparation. ( 2 ) The intervention effect was significant. The median total nosocomial process time before and after intervention were 138. 0 (118. 5,188. 8) min and 93. 5 (80. 0,114. 0) min respectively. There was significant difference(Z=5. 929,P<0. 01). Compared with before intervention,the time of examination,imaging examination, preoperative preparation and femoral artery puncture were shorter ( 16. 5 [ 10. 0, 27. 2 ] min vs. 35. 0 [18. 2,51. 8] min;10. 0 [9. 0,11. 0] min vs. 12. 5 [10. 0,23. 8] min;48. 0 [30. 0,67. 5] min vs. 60. 5 [45. 5,90. 8] min;15. 0 [12. 0,18. 2] min vs. 21. 0 [13. 0,33. 0] min,Z=4. 150,3. 685,2. 801,and 2. 852,respectively;all P<0. 05). Conclusions The nosocomial process of endovascular treatment in patients with ischemic stroke is seriously delayed. Through continuous improvement of the nosocomial process,setting up a parallel treatment modality,strengthening the stroke team training,and improving the docking measures of the information system platform can significantly shorten the in-hospital time.